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The Healthcare Matrix Improving Care by Linking ACGME Competencies
廖國臣 醫師一般內科暨高齡醫學科
林口長庚紀念醫院
Invisible doctors making a case for involving medical
residents in hospital quality improvement programs
Ashton C M
Acad Med 199368823
ldquoThe central mission of medical education is to improve the quality of health care delivered by doctors and we must never fail to remember the central role played by patients as the ultimate recipients of our skills- what
doctors do and how and when they do it depends on the quality of medical education We need to get it right
( Bligh and Parsell 2000 )
Outline
bull The Competency-based education and ACGME outcome project
bull The healthcare matrix introduction and its application
What is Competency-based education
Competency-based education focuses on learner performance ( learning outcomes ) in reaching specific objectives ( goals and objectives of the curriculum )
ACGME Accreditation Council for Graduate Medical Education
bull Founded in 1981
bull To improve health care by assessing and advancing the quality of resident physiciansrsquo education through accreditation
Website wwwacgmeorg
The Six General Competencies
bull Patient care
bull Medical knowledge
bull Practice-based learning and improvement
bull Systems-based practice
bull Professionalism
bull Interpersonal and communication skills
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Invisible doctors making a case for involving medical
residents in hospital quality improvement programs
Ashton C M
Acad Med 199368823
ldquoThe central mission of medical education is to improve the quality of health care delivered by doctors and we must never fail to remember the central role played by patients as the ultimate recipients of our skills- what
doctors do and how and when they do it depends on the quality of medical education We need to get it right
( Bligh and Parsell 2000 )
Outline
bull The Competency-based education and ACGME outcome project
bull The healthcare matrix introduction and its application
What is Competency-based education
Competency-based education focuses on learner performance ( learning outcomes ) in reaching specific objectives ( goals and objectives of the curriculum )
ACGME Accreditation Council for Graduate Medical Education
bull Founded in 1981
bull To improve health care by assessing and advancing the quality of resident physiciansrsquo education through accreditation
Website wwwacgmeorg
The Six General Competencies
bull Patient care
bull Medical knowledge
bull Practice-based learning and improvement
bull Systems-based practice
bull Professionalism
bull Interpersonal and communication skills
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
ldquoThe central mission of medical education is to improve the quality of health care delivered by doctors and we must never fail to remember the central role played by patients as the ultimate recipients of our skills- what
doctors do and how and when they do it depends on the quality of medical education We need to get it right
( Bligh and Parsell 2000 )
Outline
bull The Competency-based education and ACGME outcome project
bull The healthcare matrix introduction and its application
What is Competency-based education
Competency-based education focuses on learner performance ( learning outcomes ) in reaching specific objectives ( goals and objectives of the curriculum )
ACGME Accreditation Council for Graduate Medical Education
bull Founded in 1981
bull To improve health care by assessing and advancing the quality of resident physiciansrsquo education through accreditation
Website wwwacgmeorg
The Six General Competencies
bull Patient care
bull Medical knowledge
bull Practice-based learning and improvement
bull Systems-based practice
bull Professionalism
bull Interpersonal and communication skills
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Outline
bull The Competency-based education and ACGME outcome project
bull The healthcare matrix introduction and its application
What is Competency-based education
Competency-based education focuses on learner performance ( learning outcomes ) in reaching specific objectives ( goals and objectives of the curriculum )
ACGME Accreditation Council for Graduate Medical Education
bull Founded in 1981
bull To improve health care by assessing and advancing the quality of resident physiciansrsquo education through accreditation
Website wwwacgmeorg
The Six General Competencies
bull Patient care
bull Medical knowledge
bull Practice-based learning and improvement
bull Systems-based practice
bull Professionalism
bull Interpersonal and communication skills
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
What is Competency-based education
Competency-based education focuses on learner performance ( learning outcomes ) in reaching specific objectives ( goals and objectives of the curriculum )
ACGME Accreditation Council for Graduate Medical Education
bull Founded in 1981
bull To improve health care by assessing and advancing the quality of resident physiciansrsquo education through accreditation
Website wwwacgmeorg
The Six General Competencies
bull Patient care
bull Medical knowledge
bull Practice-based learning and improvement
bull Systems-based practice
bull Professionalism
bull Interpersonal and communication skills
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
ACGME Accreditation Council for Graduate Medical Education
bull Founded in 1981
bull To improve health care by assessing and advancing the quality of resident physiciansrsquo education through accreditation
Website wwwacgmeorg
The Six General Competencies
bull Patient care
bull Medical knowledge
bull Practice-based learning and improvement
bull Systems-based practice
bull Professionalism
bull Interpersonal and communication skills
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
The Six General Competencies
bull Patient care
bull Medical knowledge
bull Practice-based learning and improvement
bull Systems-based practice
bull Professionalism
bull Interpersonal and communication skills
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Goals of the outcome project
bull Developing competence as a physician
bull Improving patient care
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Healthcare Matrix
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
IOM ( Institute of Medicine) report in 2001
Crossing the Quality Chasm A New Health System for the 21st Century
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Crossing the Quality Chasm
There is a chasm between the healthcare that healthcare providers now provide and the healthcare that they are capable of providing
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Six aims for improving health care
Making healthcare more safe effective patient-centered timely efficient and equitable
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
ACGME states that in 706 we should have
bull Begun to use external quality measures to verify resident and program performance levels
bull Each of the IOM aims has external measures of quality
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
In the Matrix
bull The resulting IOM Aims for Improvement are linked with the ACGME Core competencies to form the Healthcare Matrix
bull Provides a way for users to examine their patient care through every facet of the Aims and Competencies thus identifying improvement opportunities
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
安全的醫療 ( Safety )
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
及時的服務 ( Timely )
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
有效用的處置 ( Effective )
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
有效率的服務 (Efficient )
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
平等的就醫 ( Equitable )
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
病人為中心 ( Patient-Centered )
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
What must we know
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
What must we say
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
How must we behave
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
What is the Process On whom do we depend
Who depends on us
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
What have we learned What will we improve
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
The matrix
bull Provides a blueprint to help residents to learn the core competencies in their daily work for caring for patients and help faculty to link mastery of the competencies with improvement in quality of care
bull Provides a framework for educators to use in curriculum and program redesign
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Clinical application
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Preparation for the Matrix
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
The Case
bull MrHung 83-year-old man hx of CAD 3-vessel-disease sp PTCA with stenting SSS sp pacemaker implantation
bull Admitted for intermittent abdominal pain for three weeks with leg edema chest pain and black stool passage
bull Transferred from LMD with suspicious of AAA related ischemic bowel syndrome
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At ER ( 2009921)
bull CT showed infrarenal AAA ( 35 mm in diameter ) with intimal flap mural thrombus and aneurysmal dilatation of bil Common iliac arteries ( Rt23 mm Lt16 mm)
bull Consulted CVS operation was not suggested
bull Admitted to CCU for tx and observation
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CCU( 2009922)
bull BP control and observation
bull Pain control (intermittent abd pain )
bull We suggested EGD study for GI bleeding but patient refused the procedure
bull GI bleeding improved after PPI use
bull Then he was transferred to CV ward
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CV ward (2009924-)
bull Pain control for intermittent abdominal pain but patient became drowsy on 926 ( favor medication related )
bull EGD was suggested again but was cancelled due to unclear consciousness
bull CVS consultation suggest CTA study
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CV ward (2009928-)
bull Marked diffuse abdominal pain occurred with muscle guarding and rebound tenderness on physical examination
bull GS was consulted for ro acute abdomen but they favored AAA related abdominal pain
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CV ward (2009929-)
bull CTA on 929 revealed aneurysm in progress with impending rupture
bull CVS was consulted and scheduled operation ( endovascular aneurysm repair EVAR) on 102
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CV ward ( 2009101)
bull Fever occurred We did infection workup
bull Ceftriaxone was prescribed for UTI
bull High fever on 102 with mild drowsy consciousness Anti was changed to Flomoxef
bull Notify CVS about fever infection state
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CV ward ( 2009102 )
bull Operation of EVAR was done as schedule
bull Progressive dyspnea with unclear consciousness was found in the evening
bull Arranged CCU transferral but patient and family refused
bull Worsening respiratory pattern occurred on 103 and the patient received intubation for impending respiratory failure
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CV ward to CCU ( 103)
bull Right monoplegia was found after intubation
bull Brain CT (-)
bull Neurologist suggested thoracic myelopathy due to lumbar plexus ischemia or myelitis MRI was indicated but not suitable for the patient due to pacemaker
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
At CCU (2009103)
bull Profound shock with lactic acidosis and conscious disturbance
bull Family requested DNR and the patient was discharged against advise critically on 103
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
In the past following issues would be discussedhellip
bull How to interpret AAA with impending rupture
bull Surgical indication for AAA and possible complication
bull Differential diagnosis of acute monoplegia
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Using the Healthcare matrix
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
是否避免意圖幫助病人的醫療行為反而傷害病人具有憐憫心同情心能
適當而有效率的診療病痛
預防疾病 增進健康與臨終照顧
No
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
減少等候時間避免造成傷害的延遲
NoNo
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
根據醫學知識提供適當 ( 不過當亦無不足 ) 的服務
NoNo No
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
避免設備藥材衛材意見或能力等資源的浪費
No No YesNo
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
不因性別種族地域與社經階級
提供同樣品質的服務
YesNo No YesNo
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
依病人個別偏好及需求提供尊重與負責任的照護並依其價值觀作臨床決策
YesNo No Yes YesNo
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
具備已確立及發展中的生物醫學臨床醫學及社會科學的知識
並能將上述知識運用至照顧病人身上
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷 與其臨床症狀與影像變
化
AAA 治療選擇其適應症與預後 疼痛處理
手術時機
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
與病人及其家人或其他醫療照護成員
建立團隊精神有效的溝通管道
與家屬溝通疾病治療目標
治療檢查之決擇
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理
No NoNo Yes Yes Yes
術前有發燒與外科醫師
討論手術時機
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
呈現實踐專業責任堅守倫理原則
尊重多樣性群體差異之行為
提供專業諮詢與建議 尊重病患決定能
力
面對家屬對於術後併發症的提問應該如何回應
No NoNo Yes Yes Yes
團隊醫師之間對病患狀況之掌握與交班
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
有熱誠理解醫療照護體系之運作及緣由
並有能力運用體系資源提供最適當的醫療照護
No NoNo Yes Yes Yes
AAA 診斷與治療系統資源運用
跨團隊合作討論治療決策
暢通科際照會系統
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
自我評估醫療行為運用科學證據提昇照護品質
No NoNo Yes Yes Yes
根據實證 建立 AAA 病
患診治之規範
落實跨科際團隊溝通與合作 提供病患延續性照顧之需求
組織 AAA
照護團隊
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
No NoNo Yes Yes Yes
AAA 瀕臨破裂之診斷
其臨床症狀與影像變化
疼痛處理手術時機
AAA 治療選擇其適應症與預後
與家屬溝通疾病治療目標治療檢查之決擇
術前有發燒與外科醫師
討論手術時機
團隊與家屬之溝通 面對醫療處置未達預
期效果或併發症後續處理提供專業諮詢與建
議 尊重病患決定
能力
團隊醫師之間對病患狀況之掌握與交班
面對家屬對於術後併發症的提問應該如何回應
AAA 診斷與治療系統資源運用
暢通科際照會系統
跨團隊合作討論治療決策
根據實證醫學
建立 AAA 病患
診治之規範
組織 AAA
照護團隊
落實跨科際團隊溝通與合作
提供病患延續性照顧之需求
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Using data from the Matrix
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Closing the patient care loop
bull Identify issues of care related to Aims and Competencies via the Matrix
bull Identify lessons learned and improvement needed
bull Complete action plan for improvements with accountabilities and timeline
bull Use quality improvement tools and methods to improve care
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Questions to ask
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Things we learned
診斷治療選擇與適應症 bull Diagnosis treatment and indications
病情解釋預後與併發症的告知與處理bull Informed consent processbull Prognostication and management of
complications
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Things we learned ( cont)
處置標準作業流程與資源運用 bull Management guideline and resource
utilization
醫病溝通與團隊溝通 bull Doctor-patient-family relationship bull Inter-professional communicationbull Multidisciplinary teamwork
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
After using the matrix
Two questions to ask
1Was the care for this patient as good as it could be
2 What improvements in the competencies of the resident and faculty and changes in the system of care would result in improved care for the next patient
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Multiple Uses in Different Specialities
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
The health care matrix formulation a tool for competency assessment in
psychiatry residency trainingAfzal KI Quinn DC Briones DF
bull RESULTS The healthcare matrix provides us with a practical tool to analyze any complex episode of patient care like the one in our psychiatric setting and allows us to learn from the shortcomings in order to improve CONCLUSION The optimal utilization of this tool in the competency assessment of psychiatry residents has an
enormous practical implication by transforming the case and morbidity and mortality conferences into a well-structured learning and improvement format
South Med J 2009 Aug102(8)789-94
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
The Healthcare Matrix
bull Used as a framework for transforming traditional MampM conferences into Morbidity and Mortality and Improvement conferences
bull Used as a structure titled Performance Management and Improvement ( PMampI) that includes use of the matrix for team learning
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Using the healthcare matrix with interns and medical students
as a tool to effect changeQuinn DC Reynolds PQ Easdown J Lorinc A
Vanderbilt University Medical Center Nashville TN USA
Each resident completed hisher own Matrix and then the group selected one Matrix as their improvement project The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed When taught the tools and methods of quality
improvement even interns can make a significant contribution to the improvement of patient care
South Med J 2009 Aug102(8)816-22
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Conclusion (1)
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Conclusion (2)
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Making Residents Visible in Quality Improvement
Carl Patow MD MPH FACS
Academic Medicine
84(12)1642 December 2009
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
ldquo All health professionals should be educated to deliver patient-centered care as members of an interdisciplinary team emphasizing evidence-based practice quality improvement approaches and informatics rdquo
Greiner AC Knebel E (Eds)
Health Professions Education A Bridge to Quality Washington DC National Academies Press 2003
Thank you
Thank you
