Improving Health: Results on PDSAs

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….