quality colloquium 2012 final
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TRANSCRIPT
Engaging And Empowering
Patients For Quality
& Safety
“e-Patient Dave” deBronkart
• High tech marketing• Data geek; tech trends; automation• 2007: Cancer kicker
• 2008: E-Patient blogger
• 2009: ParticipatoryMedicine, Public Speaker
• 2010: full time
• 2011: international
• 2012: turning the corner
Michael Millenson• Health Quality
Advisors
• Demanding Medical Excellence, Health Affairs, many more
• Board of American Medical Group Foundation, AHIMA Foundation, Soc’y for Participatory Medicine Amer Jour of Medical Quality
Rajni Aneja, MD, MBA, CPE• EVP, Joslin Diabetes
Center
• CPE / family practice
• Care Continuum Alliance
• ACPE
• Past:– CMO for WebMD– OptumHealth nat’l
medical director for disease mgmt, quality & standards
Tom Peters, MBA, PhD
• In Search of Excellence and 16 other books
• Extraordinarily diverse industry experiences
• Track record of successfully working with leaders to create change
“e-Patient Dave” deBronkart
Twitter: @ePatientDavefacebook.com/ePatientDave
LinkedIn.com/in/[email protected]
What if Duane Smith had a shared care
plan?
Proposed taxonomy of fixes
from Helen’s keynote• Putting more power in patient
hands: – Information– Tools
Proposed taxonomy of fixes
from Helen’s keynote• Putting more power in patient
hands: – Information– Tools
• Listening to what patients report from the front line
Proposed taxonomy of fixes
from Helen’s keynote• Putting more power in patient
hands: – Information– Tools
• Listening to what patients report from the front line
• Not leveraging available contributions– A squandered opportunity– Economic inefficiency
“It has taken a full century for the patient’s perspective to go from being routinely ignored to being hailed as a pillar of an ideal health care system.”
“Rethinking the relationship between the patient and professional caregivers is a cornerstone of successful health system redesign”
“Consumer engagement, whether in the exam room or in a health care organization’s boardroom, is a central element.”
“Consumer engagement, whether in the exam room or in a health care organization’s boardroom, is a central element.”
I add: same for engagement at
the bedside, too.
What happened
here??
Gawande:
• A medical miracle – a great save
Gawande:
• A medical miracle – a great save
• In stark contrast, an “epic fail”with great human cost
Gawande:
• A medical miracle – a great save
• In stark contrast, an “epic fail”with great human cost
• By the same people in the same system
What if Duane’s familyhad googled
“splenectomy”?
What happened here?
• Squandered potential value
What happened here?
• Squandered potential value
• An asset in the system (knowledge) that was not brought to the point of care at the time when it was needed
Who can solve this?
Who can solve this?
Do we pound onclinicians more?
“I want to note especially the importance of the
resource that is most often under-utilized in our information systems – our patients”
Charles Safran MD, Beth Israel Deaconess quoting his colleague, Warner Slack MDTestimony to the House Ways & Means subcommittee on health, 2004
What if the care teamhad shared the care
planwith the patient &
family?
Abington Memorial created one.
(It’s just an EMR report)
e-Patients.net founderTom Ferguson MD 1944-2006
Equipped
Engaged
Empowered
Enabled”
Doc Tom said,
“e-Patients are
Web 2.0: “When the web began to harness the intelligence of its users” – Tim O’Reilly
If the microscope’s happy
but the patient’s not,
has care been achieved?
Has optimal care??
Was the money well spentfor customer value?
This is the only industrywhere the definition of
qualitydoesn’t start
by asking customers what they want more of
A patient’s definition of quality:
Achieving everythingwe possibly can
in the family member’s care.
Compliance
ComplianceAchieveme
nt
Compliance(Whose goal is it, anyway?)
Achieveme
nt
Compliance(Whose goal is it, anyway?)
Achieveme
nt
Quality???
EMRs and Quality (NEJM)
• Patients who achieved 4 out of 5 outcomes
With EMR Paper based 44% 16%
• Patients whose care met four quality standards
With EMR Paper based 51% 7%
Peter Margolis, Cincinnati Children’s
.5 x .5 = .25
A patient’s definition of safety:
Avoiding avoidableharm and mistakes.
A patient’s definition of safety:
Avoiding avoidableharm and mistakes.
Also known as accidents.
What could possiblystop us
from speaking up to help?
Answer:We’re afraid of you.
“I want to note especially the importance of the
resource that is most often under-utilized in our information systems – our patients”
Charles Safran MD, Beth Israel Deaconess quoting his colleague, Warner Slack MDTestimony to the House Ways & Means subcommittee on health, 2004
“What is the Role of the Patient?”
“What is the Role of the Patient?”
“What is the Role of the Patient?”
Gawande at CMMI Summit
“There is a bell curve for quality – a wide gap between the best care and the worst.
Gawande at CMMI Summit
“There is a bell curve for quality – a wide gap between the best care and the worst.
“There is another bell curve for costs – again, a wide gap.
Gawande at CMMI Summit
“There is a bell curve for quality – a wide gap between the best care and the worst.
“There is another bell curve for costs – again, a wide gap.
“Surprisingly, the two curves do not match.
Gawande at CMMI Summit
“There is a bell curve for quality – a wide gap between the best care and the worst.
“There is another bell curve for costs – again, a wide gap.
“Surprisingly, the two curves do not match.
“And that means there is hope.”
“It has taken a full century for the patient’s perspective to go from being routinely ignored to being hailed as a pillar of an ideal health care system.”
“e-Patient Dave” deBronkart
Twitter: @ePatientDavefacebook.com/ePatientDave
LinkedIn.com/in/[email protected]
Let Patients HelpHeal Healthcare.