Improving Health: Results on PDSAs

25/07/2011 1:42 am | Healthcare | 4 Comments

It has been 85 days since my last journal entry. It was not writers block – well not in the traditional sense. I was blocked from writing due to my spare time being taken up with numerous opportunities to test my Care Book, Care Map, and Goal Sheet! And even more time to think about the results of the tests (PDSAs in improvement language) while being laid up from rotator cuff surgery which greatly hampered my keyboarding. Hence, my first blog back will be a report on the interesting (well at least I think so:-) outcomes of these multiple tests since the results were often different than predicted and I definitely bumped into some incidental learning!

CARE BOOK RESULTS: I thought providers would be interested in my Care Book. I did not expect them to go through the book –but I did predict (expect) some positive feedback towards the effort to organize my own medical history. This did not happen. In my six (or was it seven?) tests using my Care Book only one provider asked to see anything in the book. And this was only after he learned I had seen a specialist whom he admired. He took my book and read the consult word for word (and not surprisingly agreed with the diagnosis).

I was surprised in one situation when the word “evidence” was used in an initial encounter. I was so surprised I giggled. Then I realized no one else was laughing. I was puzzled at first, then began to theorize that perhaps when a patient shows up in the office for a first visit (or first in a long time visit) carrying her records in a two-inch note book systematically categorized it might be perceived in a less than positive light. Perhaps it might even be perceived as a warning of potential litigation? Hmmm… thoughts anyone?

CARE MAP RESULTS: I also expected some positive feedback on my Care Map. This was not an unfounded expectation – the first Care Map I created was for my mother many years ago and her oncologist was ever so impressed! My providers – not so much.

There was one exception. (Well one in addition to the front office people who really appreciated all of my information in a readable manner given my less than legible handwriting.) A PA at my dermatology consult did bring the Care Map I had left for her at check-in with her to the room. She reviewed and highlighted pertinent areas as she talked “with” me to clarify her questions.

An interesting observation for me about both my Care Book and Care Map was how both documents allowed me to share quickly and with confidence my history and experience. For no other reason I will continue to use the Care Map and keep the Care Book updated ( taking it with me to most of my medical appointments.)

GOAL SHEET RESULTS: I have to say I did not initially have much confidence in the Goal Sheet. Although as reported previously my first experience using it was very positive. Turns out – every provider paid attention to my Goal Sheet. The PA I mentioned previously used my Goal Sheet as a guide to our discussion and examination which was one of the most “partnering” visits I have ever experienced. I was greatly encouraged by this encounter.

I am surprised how much this little bit of reflection- taking time to do a Goal Sheet – helps me crystallize what I want and need from the medical visit and therefore helps me get what I need. But even more remarkably, I think the Goal Sheet helps to create an environment of equality and foster “with” conversations verses only conversations of what the provider can do “for” me or “to” me.

A welcome transformation….

  • WHERE AM I?

    And in the end, it's not the years in your life that count. It's the life in your years.Abraham Lincoln

    I continue to be full of activity with good work and great people. Thankful my dream became a reality and I remain healthy enough to continue the journey.

    Every once in a while however thankful seems way to small ....time stops and life hits me square in the face. That happened this week with the loss of a colleague... a friend in the journey.

    Divvie Powell passed peacefully this week after a long and courageous struggle with Myeloma. She is described by her long-time friend Pat Heinrich as "a Nurse and a Quality Improvement Expert....who first changed the lives of her patients and then expanded her reach to inspire countless physicians, nurses, and staff to devote their best efforts to quality and systems improvement in health care and public health."

    I am grateful that we met on the journey and deeply saddened by her passing ... my heart goes out to her family and friends.

  • NEWS

    • The Institute for Healthcare Improvement CEO Maureen Bisognano has been named to Modern Healthcare's 2011 "Top 25 Women in Healthcare." See more at IHI.org.

    • A thoughtful article addressing the issues of Health care executives called upon to shape the views, perspectives, and behaviors of the individuals throughout their organization to achieve patient- and family-centered care was recently published by Jane Taylor and Pat Rutherford in Frontiers of Health Services Management. 2010 Summer;26(4):3-14. This article uses Kouzes and Posner's leadership framework to outline the how and give examples of practice from the Institute for Healthcare Improvement are included to support this idea: The pursuit of genuine partnerships with patients and family members: The challenge and opportunity for executive leaders. Link to this article resides on IHI.org.

    • Vermont Oxford Network is pleased to present the eBook - NICQ 2007: Improvement in Action - edited by Jeffrey D. Horbar, MD, Kathy Leahy and James Handyside. This ebook is the culmination of NICQ 2007, a two-year improvement collaborative involving teams of neonatal professionals and families representing 46 hospitals in North America whose goal was always to provide care that is family centered, safe, effective, equitable, efficient, timely and socially and environmentally responsible. The chapters addressing these 7 domains were written by invited experts and illustrated with improvement stories from teams that participated in the collaborative. Link to book resides on http://www.vtoxford.org