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Biomedical subjects

P B Batalden

Publications and source records attributed to P B Batalden.

At least 19 recordsLinked to original sources
PubMed2002

Improving safety on the front lines: the role of clinical microsystems.

The clinical microsystem puts medical error and harm reduction into the broader context of safety and quality of care by providing a framework to assess and evaluate the structure, process, and outcomes of care. Eight characteristics of clinical microsystems emerged from a qualitative analysis of interviews with representatives from 43 microsystems across North America. These characteristics were used to develop a tool for assessing the function of microsystems. Further research is needed to assess microsystem performance, outcomes, and safety, and how to replicate "best practices" in other settings.

Health Services Research↗
PubMed2001

Using an improvement model to reduce adverse drug events in VA facilities.

BACKGROUND: Adverse drug events cause significant morbidity and mortality in health care. Many adverse drug events are due to medication errors and are preventable. In 1999 and 2000 the Patient Safety Center of Inquiry collaborated with the Institute for Healthcare Improvement (IHI) to implement a quality improvement (QI) project designed to reduce medication errors within the Veterans Administration system. METHODS: During a 6- to 9-month period, interdisciplinary teams that want to achieve much higher levels of performance work on a common aim, under the guidance of faculty, and come together for three 2-day educational and planning sessions. Between these sessions, teams implement some of the suggested changes, measure the results of those changes, and report back to the larger group. RESULTS: During the formal project, teams collected allergy information on more than 20,000 veterans and averted 1,833 medication errors that had the potential to cause adverse events. At 6-month follow-up, the majority of teams remained intact, continued to collect data, and maintained their gains, approximately doubling the results obtained during the formal project. Half of the teams expanded their efforts to other settings, and one-third of the teams expanded beyond their original topics. Returns on investment in the QI effort were substantial. CONCLUSIONS: The results suggest that gains made in organized QI efforts can be maintained for 6 months without additional external support or coaching if team structure and leadership support remain intact. Facilitators of QI efforts should focus on teams that are having difficulty learning new techniques. Finally, this effort appeared to generate cost savings.

Cost Savings↗
PubMed2000

Using the Baldrige management system framework in health care: the Veterans Health Administration experience.

BACKGROUND: In 1998 the Veterans Health Administration (VHA) developed the Quality Achievement Recognition Grant, a competitive grant application open to all Veterans Integrated Service Networks (VISNs) within the VHA system and based on the Baldrige management framework. Eight of the 22 VISNs attended the educational programs and initiated the grant application process; 7 completed applications. Team award experts from VHA and external sources reviewed, scored, and wrote feedback reports to all applicants and conducted four site visits. IDENTIFICATION OF BEST PRACTICES AND RECOMMENDATIONS FOR FUTURE APPLICANTS: Each application was compared to examples of ideal applications to identify areas of excellence and areas for improvement. In general, the best applicants identified and described key processes and articulated the methods used to evaluate and improve processes. For example, they were able to identify the process used to incorporate key constituents into the strategy development process. One applicant developed a series of management advisory committees, the membership of which includes veterans' service organizations, academic affiliates, community members, and congressional delegates, which were tapped to develop a strategic plan. Leading applicants in the future are likely to be able to demonstrate evidence of deployment and constant review of the strategy and to emphasize the human resources plan into the strategic planning and deployment. CONCLUSIONS: The Baldrige management framework is a useful tool for identification of areas of achievement and areas for improvement within the VHA. Potential applicants for the award could benefit from ensuring coherence across the application, placing a greater emphasis on work systems, and incorporating more extensive analysis of market conditions.

Awards and Prizes↗
PubMed2000

Using early clinical experiences to integrate quality-improvement learning into medical education.

Health care providers are delivering care in an increasingly complex environment; this requires that providers develop new competencies to better understand their work and to design changes that can help them succeed. Recognizing these new educational requirements, Dartmouth Medical School created a model two-pronged program for teaching quality improvement to its medical students. The goal of the program is to provide students with an active learning experience as well as an education in the theory and application of continuous quality improvement. The program includes two educational experiences: one curriculum is for all medical students and the other is for selected, highly motivated students. The first curriculum is incorporated in Dartmouth's required "On Doctoring" course, in which students spend time with community-based physician preceptors. The quality-improvement curriculum is designed around an improvement project developed at the students' preceptor sites. The second curriculum for students with a special interest in quality improvement is offered as an elective summer program between the first and second years of medical school. Working in groups of two, students identify an area for improvement within a preceptor's practice, assist the practice in articulating an improvement plan, help implement that plan, and write up their experiences. The authors describe the two curricula, factors associated with their successful implementation, and lessons learned.

Clinical Competence↗
PubMed1998

Building measurement and data collection into medical practice.

Clinicians can use data to improve daily clinical practice. This paper offers eight principles for using data to support improvement in busy clinical settings: 1) seek usefulness, not perfection, in the measurement; 2) use a balanced set of process, outcome, and cost measures; 3) keep measurement simple (think big, but start small); 4) use qualitative and quantitative data; 5) write down the operational definitions of measures; 6) measure small, representative samples; 7) build measurement into daily work; and 8) develop a measurement team. The following approaches to using data for improvement are recommended. First, begin with curiosity about outcomes or a need to improve results. Second, try to avoid knee-jerk, obstructive criticism of proposed measurements. Instead, propose solutions that are practical, goal-oriented, and good enough to start with. Third, gather baseline data on a small sample and check the findings. Fourth, try to change and improve the delivery process while gathering data. Fifth, plot results over time and analyze them by using a control chart or other graphical method. Sixth, refine your understanding of variation in processes and outcomes by dividing patients into clinically homogeneous subgroups (stratification) and analyzing the results separately for each subgroup. Finally, make further changes while measuring key outcomes over time. Measurement and improvement are intertwined; it is impossible to make improvements without measurement. Measuring and learning from each patient and using the information gleaned to test improvements can become part of daily medical practice in local settings.

Blood Glucose Self-Monitoring↗
PubMed1998

Collaboration in improving care for patients: how can we find out what we haven't been able to figure out yet?

BACKGROUND: Questions, or what the physicist and learning expert Reginald Revans called "insightful inquiry," are essential to learning. People remember and use what they discover themselves. But many habits and activities in front-line workplaces of patient care have not promoted frank discussions of what we haven't figured out yet about improving care for patients. Leaders are no longer defined by having the right answers. Leaders will be the ones who have the right questions and who promote local learning with the right questions. SUGGESTIONS FOR GETTING STARTED IN COLLABORATION. The authors suggest questions to ask to get collaborative inquiry going and cite examples they have collected. The questions and examples are grouped in seven thematic categories: Listening to and appreciating others; Thinking across disciplines and roles; Sharing ideas and linking those shared ideas to execution and deployment of change; Appreciating systems and interdependencies; Using research (including local research) to inform our practices; Using methods, skills, and techniques as facilitators of collaboration; and Working across organizational boundaries.

Communication↗
PubMed1998

Building a quality future.

How can healthcare leaders stay ahead of the curve? What can they do to see what the future holds and to secure a place for their employees and their organizations? They must begin doing today what they need to do to survive tomorrow. Furthermore, they must take wise action today or there will be no tomorrow. This article looks into the future and connects it with what we must see and do today. The article begins with a glimpse of the future and with an exploration of what people really want from health and healthcare. Next, it examines what appear to be inexorable megatrends and healthcare trends that are sweeping through society. This leads us to consider the quality and value imperatives that must be faced to secure a stake in the healthcare delivery. We will discuss a model for managing care for individual patients and small populations by focusing on where patients, populations, and caregivers meet--at the front lines of patients care. We conclude with some advice on how to build sustainable organizations by exploiting the inevitable.

Delivery of Health Care↗
PubMed1997

Clinical process cost analysis.

BACKGROUND: New systems of reimbursement are exerting enormous pressure on clinicians and hospitals to reduce costs. Using cheaper supplies or reducing the length of stay may be a satisfactory short-term solution, but the best strategy for long-term success is radical reduction of costs by reengineering the processes of care. However, few clinicians or institutions know the actual costs of medical care; nor do they understand, in detail, the activities involved in the delivery of care. Finally, there is no accepted method for linking the two. METHODS: Clinical process cost analysis begins with the construction of a detailed flow diagram incorporating each activity in the process of care. The cost of each activity is then calculated, and the two are linked. This technique was applied to Diagnosis Related Group 75 to analyze the real costs of the operative treatment of lung cancer at one institution. RESULTS: Total costs varied between $6,400 and $7,700. The major driver of costs was personnel time, which accounted for 55% of the total. Forty percent of the total cost was incurred in the operating room. The cost of care decreased progressively during hospitalization. CONCLUSIONS: Clinical process cost analysis provides detailed information about the costs and processes of care. The insights thus obtained may be used to reduce costs by reengineering the process.

Cost Control↗
PubMed1997

Building knowledge of health care as a system.

A system is a functionally related group of interacting, interrelated, or interdependent elements forming a complex whole with a common aim. This article presents a method--a 10-step exercise--for building knowledge of the elements of an interdependent system of health care. Those who seek to improve the work of a system can use this exercise for designing and relating new improvement efforts to the general work of the organization.

Delivery of Health Care, Integrated↗
PubMed1997

Continually improving the health and value of health care for a population of patients: the panel management process.

Today's primary care provider faces the challenge of caring for individual patients as well as caring for populations of patients. This article offers a model--the panel management process--for understanding and managing these activities and relationships. The model integrates some of the lessons learned during the past decade as we have worked to gain an understanding of the continual improvement of health care after we have understood that care as a process and system.

Community Health Planning↗
PubMed1997

Clinical process cost analysis: a promising tool for clinical improvement.

In today's environment, health care organizations are expected to provide the best possible care at the lowest possible cost. Neither aspect can be considered independently, but correlating the two with traditional systems of cost analysis is very difficult. This article presents a new method for linking costs to the process of care that also promises to be a powerful tool for clinical improvement and redesign.

Accounting↗
PubMed1996

Improving health care, Part 1: The clinical value compass.

CLINICAL VALUE COMPASS APPROACH: The clinical Value Compass, named to reflect its similarity in layout to a directional compass, has at its four cardinal points (1) functional status, risk status, and well-being; (2) costs; (3) satisfaction with health care and perceived benefit; and (4) clinical outcomes. To manage and improve the value of health care services, providers will need to measure the value of care for similar patient populations, analyze the internal delivery processes, run tests of changed delivery processes, and determine if these changes lead to better outcomes and lower costs. GETTING STARTED--OUTCOMES AND AIM: In the case example, the team's aim is "to find ways to continually improve the quality and value of care for AMI (acute myocardial infection) patients." VALUE MEASURES--SELECT A SET OF OUTCOME AND COST MEASURES: Four to 12 outcome and cost measures are sufficient to get started. In the case example, the team chose 1 or more measures for each quadrant of the value compass. OPERATIONAL DEFINITION OF MEASURES: An operational definition is a clearly specified method explaining how to measure a variable. Measures in the case example were based on information from the medical record, administrative and financial records, and patient reports and ratings at eight weeks postdischarge. COMMENTS: Measurement systems that quantify the quality of processes and results of care are often add-ons to routine care delivery. However, the process of measurement should be intertwined with the process of care delivery so that front-line providers are involved in both managing the patient and measuring the process and related outcomes and costs.

Cost-Benefit Analysis↗