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Competency, Quality, and Public Expectations in the Emerging Healthcare World


Published on

2017 Annual Meeting

Published in: Education
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Competency, Quality, and Public Expectations in the Emerging Healthcare World

  1. 1. |||© 2017 MCC | CMC #MCCam #aaCMC© 2017 MCC | CMC Steven Lewis, President Access Consulting Ltd., Saskatoon Adjunct Professor of Health Policy Simon Fraser University Competency, Quality, and Public Expectations in the Emerging Healthcare World
  2. 2. ||#MCCam #aaCMC© 2017 MCC | CMC 2 My Starting Points  What we mean by performance should drive regulatory and competency assessment policies and practices  There is a difference between basic competency and excellence  Be guided by what the public should expect, not what it does  Many have roles in quality improvement and making the system work better  Contemporary notions of excellence go well beyond technical competency  Automation and Artificial Intelligence will have profound consequences for professional practice
  3. 3. ||#MCCam #aaCMC© 2017 MCC | CMC 3 What Defines A High Performing Health Care System?  Patient-centered (responsive, convenient, inclusive, culturally aware)  Patients have the option of being full partners in their care  Care is effective – it makes health status better than would be the case were it not provided  Care is efficient – timely, cost-effective, right people, right place  Care is appropriate – it is clearly better than not doing it  Care is compassionate  Care is based on best available evidence
  4. 4. ||#MCCam #aaCMC© 2017 MCC | CMC 4 A High-Performing Physician in a High-Performing System  Has sound knowledge base in health and medicine  Works effectively in teams  Encourages self-management  Speaks truth to patients - frames issues and care choices to support genuine patient co-management and decision-making  Avid consumer of high quality scientific evidence  Engaged in peer review and support, efforts to identify and reduce unwarranted variations in practice  Good steward of resources
  5. 5. ||#MCCam #aaCMC© 2017 MCC | CMC 5 What Qualities Define A High-Performing Physician  Intelligence (but not necessarily superior)  Empathy – the capacity to see things from the patient’s perspective  Humility – awareness of clinical uncertainty and the challenges of effectively serving a complex, multi-morbid population  Curiosity, especially about what matters to patients  Drive, to be better, and use failure as a springboard for innovation  Respect for other team members – hierarchy is the enemy of excellence  Introspection – capacity to reflect on strengths and weaknesses, recognize risk factors for burnout and substance abuse
  6. 6. ||#MCCam #aaCMC© 2017 MCC | CMC 6 Where Patients Are Most Vulnerable  We don’t understand what our physicians are telling us – but the physicians don’t know it  We are subject to major practice variations – but we don’t know that they exist, their distribution, and their consequences  The decision architecture is biased – we are offered choices framed to nudge us to choose what the physician wants us to choose  Messages are definitive where the evidence is far less conclusive  “you’d be crazy not to have a mammogram”  “you need knee arthroscopy”
  7. 7. ||#MCCam #aaCMC© 2017 MCC | CMC 7 What Does “Mastery” Mean In Tomorrow’s World?  In many technical areas machines outperform humans  Decision algorithms often (usually?) produce better outcomes overall that real-world practice  Facial analysis software can diagnose rare genetic diseases  “Deep learning” by computers combing through EHRs now surpass human experts in diagnostic accuracy  The value proposition for clinicians is changing  Harnessing the power of technology and data  Organizing and managing relevant information  Applying “soft skills’ to patient encounters and care plans
  8. 8. ||#MCCam #aaCMC© 2017 MCC | CMC 8 Implications for Competency  Continuous and adaptive learning is more important than formative education  Knowing when to defer to and overrule machine-based learning and pattern recognition is critical skill  Ability to access relevant information more important than how much information is stored in the brain  The ancient arts of keen observation and deep listening get upgraded as critical attributes  Generalism and a holistic perspective become newly valued as keys to effective management of complexity
  9. 9. ||#MCCam #aaCMC© 2017 MCC | CMC 9 Everything I Want to Know About My Doctor – But Will Always Be Afraid to Ask  How do you define “normal” – are you an aggressive or a conservative diagnostician?  How do you make decisions about population screening for prostate cancer, breast cancer, and osteoporosis?  Do you know your practice patterns in relation to your peers? Do you want to know? Are you prepared to change?  Do variations in practice disturb you? Do you participate in peer- driven efforts to identify and reduce variations? Do you change?  Do you routinely compare pharmaceutical vs. other approaches to management of conditions? Do you lean one way or the other?  Do you endorse and practice according to Choosing Wisely Canada?
  10. 10. ||#MCCam #aaCMC© 2017 MCC | CMC 10 How All of This Challenges Assessment and Regulation  A great deal of what I want to know is about character, medical and health philosophy, and habits of mind  We need proxies for these attributes that are valid, reliable, and measurable, e.g.  Do you seek out and receive absolute and comparative analysis on your own practice?  Do you use decision support software to inform your decision- making?  Do you participate in peer processes to improve quality?  Do you use communications technologies to interact with patients for whom they are more convenient than an in-person visit?
  11. 11. ||#MCCam #aaCMC© 2017 MCC | CMC 11 What You Do vs. What You Mandate Others to Do  Health care excellence is a multi-level enterprise  Policy  Organizational leadership  Clinical leadership and management  Individual behaviour  Putting the “C” in CQI de-emphasizes periodic cross-sectional reviews and promotes ongoing, data-driven adaptation  Ideally assessment would be more automated, less labour-intensive, and more decentralized  Historical approaches built for highly autonomous practice  This is changing and assessment must change with it
  12. 12. ||#MCCam #aaCMC© 2017 MCC | CMC 12 Drawing All of This Together  Mandate what is essential to assessing technical competence (EHR, core conceptual and empirical knowledge)  Insist on a health information system that generates meaningful information on valid and reliable quality indicators  Patient experience measures  Attributable clinical outcomes (patient-reported outcomes measures and others)  Measure key attributes such as empathy, curiosity, ability to function in teams, and relevant clinical attitudes  Ensure that findings are actionable
  13. 13. ||#MCCam #aaCMC© 2017 MCC | CMC 13 Back to Your Roles….  As a patient, what would give me more confidence:  My doctor is certified competent by RCPS/CCFP/MCC  The local hospital/health centre/region tells me what QI processes are in place and publishes relevant performance data  CQI is ultimately local  Employers and peers have a responsibility to ensure the quality of the workforce and the quality of the work  The regulatory and assessment apparatus cannot compensate for a substandard workplace culture that does not take quality seriously
  14. 14. ||#MCCam #aaCMC© 2017 MCC | CMC 14 What the Public Should Expect of You  Define competency and performance in terms meaningful to us  Mandate the elements of the environment that must be present to nurture and enhance performance  Integrate the QA and QI process – professional and organizational regulation should be fully aligned  Make the process transparent – mandate that the public is able to know what insiders know about competency and performance  Do less yourselves and mandate that others do more – if you can negotiate it
  15. 15. |||© 2017 MCC | CMC #MCCam #aaCMC© 2017 MCC | CMC THANK YOU! You can anticipate and co-create the future or have it toss you around and maroon you on an island of irrelevance. 306-343-1007