by Ted Eytan, on 25 May 2007 08:31 am
The Journey | Tags: member voice
Voice of the Member, Day 3
Written by Donna Kerr, Group Health patient:
I am participating in this Quality Improvement Support Team as a patient participant. However, in doing so, I do not check my own professional expertise at the door. Patients are, of course, not only patients. As a patient, I am keenly interested in understanding what accounts for this wonderfully effective process for strengthening my healthcare system. Having entrusted my healthcare to this organization, I want to understand the “magic” of QISTing well enough to explain it. As a person who also has leadership and hands-on experience in the development of institutions with quality measures in mind, I want try to figure out how QISTing works. (Here’s follows what I am learning, though clearly I may have relearning to do and would appreciate feedback in this regard.)
It is obvious to me that QISTing doesn’t just happen. What looks like magic is not. The assemblage of the pertinent clinical, informatics and organizational expertise reflects both a commitment by top-level leadership and considerable advance work. In turn, a decision at the top to commit the resources doesn’t just happen.
Courage in leadership. We QISTers have been focusing on supports for the treatment of hypertension this week. As a patient, it has occurred to me that if I were to have consistently elevated blood pressure, I might not want to acknowledge the numbers. Having hypertension with all its dangers would not accord with how I want to view myself. Indeed, wanting to see myself as a highly competent, vigorous person in charge of my own fate, I might well be inclined to ignore the unwelcome BP numbers. Similarly, I can imagine that the leadership of my healthcare organization might not want to attend to HEDIS numbers that do not bespeak the quality of performance claimed in the branding, boilerplate for donors, and self-images of administrative competence. Hence, one of the necessary components for QIST to work is leadership’s courage – the courage to acknowledge inconvenient, unflattering facts and the courage to commit the needed resources.
Bundling clinical and informatics expertise in both the team and the process. This is one of those times when saying the obvious has a purpose. QISTs are supported by an organizational entity entitled the “Clinical Information System.” The success of this entity depends crucially upon the fact that it brings together clinical and informatics expertise. Several correlative facts might not be so obvious – facts that remind us that QISTS have distinct uses and limits:
(1) QISTs can address only problems that lend themselves to extant information or information categories; they regard populations and not individuals. Put otherwise, their solutions would not regard me and my particular concerns, but populations and categories of health data and diagnoses.
(2) QISTs produce solutions exclusively in the form of computer-managed information.
(3) QIST solutions do not call for acquiring new clinical knowledge, but instead ask clinicians to bring to mind things they already know when thinking about individual patients. QISTS do not probe clinical judgment or occasion further education.
(4) The Clinical Information System succeeds in using the QIST as a tool only in measure that it constitutes a team that puts clinical and informatics together in describing and modifying actual work flows around the selected issue.
(5) The QIST work plan does more than bring the pertinent expertise to the table to generate a solution; it also includes a process that test drives the solution in the context of local clinical work flows prior to system-wide implementation. That is, the pertinent clinical expertise includes, of necessity, those who are themselves immersed in and responsible for work flows.
Tending relationships. While leadership and clinical-informatics expertise are essential elements of the QIST “magic,” there is a third essential leg: careful attention to the relationships among team members. This thoughtful attention to relationships is necessary and not just nice, though participating on a QIST clearly feels good! Persons are invited to be a part of the team precisely because they have expertise and experience pertinent to the work flow that is under the microscope. Engagement of that expertise requires tending the human relationships.
The process will succeed only if team members feel that the environment is safe for speaking the truth about work flows, that their contributions are valued, and that part of everyone’s job is to honor the contributions of others. In other words, it is not some disembodied QIST process that produces the needed solutions; it is persons standing in relationship to one another who get the job done. Lest this point risk seeming too vague, I hasten to add specifics. I find extraordinary the genuine solicitousness, the expressions of appreciation (including applause) and the sense of collective energy that permeate at least this QIST’s work.
What is being built here is not just better healthcare delivery around a specific issue, but also a healthier healthcare organization. That makes me pleased to be a member both of this team and of this healthcare cooperative.