The NYIT College of Osteopathic Medicine is accredited by the American Osteopathic
Association to provide Osteopathic Continuing Medical Education for physicians. The
NYIT College of Osteopathic Medicine anticipates CME credits for a maximum of 5
hours and will report CME and specialty credits commensurate with the extent of the
physician’s participation in this activity.
Wednesday, November 288:30 a.m. - 3:05 p.m. (EST) W. Kenneth Riland Health Care Center- AuditoriumNYITCOM- Old Westbury Campus
FALL 2018
GRAND
ROUNDS
NYCOMEC
Program Guideth
NYCOMEC.org @NYCOMECCorp
PROGRAMSCHEDULE
Registration and Breakfast WelcomeBette Coppola, M.Ed., Education Manager, NYCOMEC "Your First Job- What You Weren't Taught in Medical School"John Kraljic, J.D., Partner, Garfunkel Wild, P.C. Remarks, New York State Osteopathic Medical Society (NYSOMS)Sherman Dunn, D.O., President Break "Palliative Care: It’s Always Too Early Until It’s Too Late"Alan Roth, D.O., FAAFP, Director of Medical Education, MediSys Health Network Research Options: NYCOMEC Poster CompetitionDavid Yens, Ph.D., Director, Research, NYCOMEC "Why I DO Research”William Doss, D.O., Nassau University Medical Center NYCOMEC Trainee Committee AnnouncementStephanie LaBarbera, M.H.A., Manager, Trainee Services, NYCOMEC Lunch GreetingDavid Broder, D.O., FACP, FACOI, President, NYCOMEC "American Osteopathic Association (AOA) Update for Students and Residents"Ronald R. Burns, D.O., President-elect, American Osteopathic Association "Personal Experiences and Lessons Learned in Combat"Philip Volpe, D.O., Major General, United States Army (ret) Break "Practical Approaches for Clinicians to Lead and Engage in Quality & Patient Safety"Zeynep Sumer King, M.S., Greater New York Hospital AssociationHillary Jalon, M.S., New York City Health & Hospitals Closing Bette Coppola, M.Ed.
8:30 a.m.
9:15 a.m.
9:20 a.m.
10:15 a.m.
10:20 a.m.
10:25 a.m.
11:10 a.m.
11:15 a.m.
11:20 a.m.
11:25 a.m.
12:05 p.m.
12:10 p.m.
1:00 p.m.
2:00 p.m.
2:05 p.m.
3:05 p.m.
NYCOMEC.org @NYCOMECCorp
NYCOMECCORP.
NYCOMEC is an Osteopathic Postdoctoral Training Institution (OPTI) that is
comprised of the NYIT College of Osteopathic Medicine, Touro College of
Osteopathic Medicine, and twenty-seven (27) teaching healthcare facilities
located in New York, New Jersey and Arkansas.
We would like to thank the American Osteopathic Association, Garfunkel Wild,
P.C., Greater New York Hospital Association, MediSys Health Network, and New
York City Health & Hospitals for their generous support.
About NYCOMEC
SAVE THE DATES FOR UPCOMING
NYCOMEC PROGRAMS!
To register for an upcoming program or webinar, please contact:
Ms. Alana Berg
[email protected] or 516.686.1128
Faculty Development Program
Osteopathic Recognition WebinarWednesday, December 5th
Wednesday, December 19thWednesday, January 2ndWednesday, January 5th
Wednesday, January 30th
Thursday, February 14th
NYCOMEC.org @NYCOMECCorp
Catskill RegionalMedical Center
Harris, NY
Coney Island Hospital
Brooklyn, NY
Eastern Long Island Hospital
Greenport, NY
Ellis Medicine
Schenectady, NY
Flushing HospitalMedical Center
(MediSys Health Network)
Flushing, NY
Good SamaritanHospital Medical Center
West Islip, NY
Gurwin Jewish Nursing & Rehabilitation Center
Commack, NY
Hackensack Meridian Health:Palisades Medical Center
North Bergen, NJ
Jamaica HospitalMedical Center
(MediSys Health Network)
Jamaica, NY
Jersey CityMedical Center
(RWJBarnabas Health)Newark, NJ
Long IslandCommunity Hospital
Patchogue, NY
MaimonidesMedical Center
Brooklyn, NY
Nassau UniversityMedical Center
East Meadow, NY
New York Institute ofTechnology College ofOsteopathic Medicine
Old Westbury, NY&
Jonesboro, AR
Newark BethIsrael Medical Center(RWJBarnabas Health)
Newark, NJ
NYU Langone
Hospital: Brooklyn
Brooklyn, NY
Orange RegionalMedical Center
Middletown, NY
Parker Jewish Institutefor Health Care & Rehabilitation
North Bergen, NJ
Peconic BayMedical CenterRiverhead, NY
Plainview HospitalPlainview, NY
Saint BarnabasMedical Center
(RWJBarnabas Health)Livingston, NJ
Sisters of
Charity HospitalBuffalo, NY
South Nassau
Communities HospitalOceanside, NY
Stony Brook
Southampton HospitalSouthampton, NY
St. Barnabas Hospital
Bronx, NY
St. Bernards Medical CenterJonesboro, AR
The Institute
for Family HealthKingston, NY
Touro College of
Osteopathic MedicineHarlem, NY
&
Middletown, NY
Wyckoff HeightsMedical Center
Brooklyn, NY
MEMBERINSTITUTIONS
NYCOMEC.org @NYCOMECCorp
PRESENTERINFORMATION
John Kraljic, J.D.
Biography:
9:20 a.m.
"Your First Job-What You Weren't Taught in Medical School"
John P. Kraljic, a Partner in Garfunkel Wild, P.C.’s Business Practice Group, has over twenty years
experience in the healthcare field. Mr. Kraljic's practice at Garfunkel Wild, P.C. includes
corporate transactions for hospitals, physicians, and other health care industry providers. He
has extensive experience in preparing and negotiating employment agreements, structuring
asset and stock acquisition agreements and preparing license agreements. In addition, Mr.
Kraljic has worked on matters relating to not-for-profit corporate governance and tax issues for
large and small hospital and health system clients. Prior to joining the Garfunkel Wild, P.C., Mr.
Kraljic practiced general corporate and corporate bankruptcy law for eleven years. Mr. Kraljic
received his B.A. from Long Island University/C.W. Post College in 1984 and his J.D. from
Georgetown University Law Center in 1987.
GW GARFUNKEL WILD, P.C.AT TO R N E Y S AT L AW
NEW YORK NEW JERSEY CONNECTICUT
© 2018 GARFUNKEL WILD, P.C.
GW GARFUNKEL W I LD, P. C .A T T O R N E Y S A T L A W
Great Neck, NY(516) 393‐2200
Hackensack, NJ(201) 883‐1030
Stamford, CT(203) 316‐0483
Albany, NY(518) 242‐7582
© 2018 GARFUNKEL WILD, P.C.
Your Graduated from Medical School – What You Were NOTTaught About Your First Job
NEW YORK NEW JERSEY CONNECTICUT
GW GARFUNKEL W I LD, P. C .A T T O R N E Y S A T L A W
© 2018 GARFUNKEL WILD, P.C.
CONGRATULATIONS! – NOW WHAT?
STEP 1 – GO FIND A JOB!!!
© 2018 GARFUNKEL WILD, P.C.4GW www.garfunkelwild.com
POTENTIAL EMPLOYERS
• Physician Practices:• Advantages: Opportunity to Become an Owner
Less Bureaucratic (usually)
• Disadvantages: Decline of Independent Practices
Possibly Less Job Security
• Hospitals:• Advantages: Job Security?
Better Benefits and PTO (usually)
• Disadvantages: No Ownership
Possible Limits on Promotional Opportunities
BureaucraticWho should you pick? TALK TO PEOPLE!!!
© 2018 GARFUNKEL WILD, P.C.5GW www.garfunkelwild.com
TERM SHEET
Is one required? NO
Are there advantages? Sometimes
• Two Caveats:
1. Makes Sure That the Term Sheet is Non‐Binding
2. You May Want to Consult a Lawyer At This Stage – if not earlier
© 2018 GARFUNKEL WILD, P.C.6GW www.garfunkelwild.com
EMPLOYMENT AGREEMENTS
Will Vary by Type of Employer
• Practices – typically are “all encompassing” and are lengthier
• Hospitals – often are short but refer to policies, guidelines, etc.
Usually, there is no such thing as a template. Every transaction stands on its own.
THOROUGHLY REVIEW THE AGREEMENT
• And pay special attention to defined terms!
© 2018 GARFUNKEL WILD, P.C.7GW www.garfunkelwild.com
BASE COMPENSATION
• See if Base Compensation includes annual increases, or atleast COLA.
• For Hospital Agreements, Base Compensation is often guaranteed only for a certain period of time and then goes toan “eat what you kill model”
© 2018 GARFUNKEL WILD, P.C.8GW www.garfunkelwild.com
INCENTIVE COMPENSATION
• Can be based on personally performed collections, wRVUs or discretionary
• Discretionary has many disadvantages!!!
• Collections – typically based on a percentage of collectionsfrom personally performed services over a threshold – the threshold is typically twice the Base– Note: Try to get increased percentages the higher the amount
collected!
• Make sure there is a provision for collections received post‐termination
• wRVUs – common in Hospital AgreementsFor both collections and wRVU‐based compensation, the numbers may look nice, but
are they realistic?
© 2018 GARFUNKEL WILD, P.C.9GW www.garfunkelwild.com
BENEFITS AND VACATION
Benefit and Vacation Packages may be governed by Employer Guidelines
But there are some things to check and ask for:• Moving Expenses
• Extra time off for board examinations
• Reimbursement for license/DEA fees, accreditation fees, CME
• Roll‐over of unused vacation days
• Medical/Maternity leave – there are differences based on the size of the employer and location of the practice
• Parking
• Telephone
© 2018 GARFUNKEL WILD, P.C.10GW www.garfunkelwild.com
BILLINGS
• The Employment Agreement usually includes a general provision under which you assign all your rights to bill and collect to the employer
– See if you can get an indemnity
– Make sure that there is an exception for collections from moonlighting
© 2018 GARFUNKEL WILD, P.C.11GW www.garfunkelwild.com
HOURS
• Usually hours are not fixed but generically refer to full‐time employment
• See if you can get some limitation on your schedule, e.g., no weekend office hours
• Call Obligations – try to get same limited or fixed
• Do you want to Moonlight? And keep the compensation from same?
© 2018 GARFUNKEL WILD, P.C.12GW www.garfunkelwild.com
PROFESSIONAL LIABILITY INSURANCE
Know the difference between Claims Made and Occurrence Policies
Claims Made Requires a Tail. The question is – who pays?
KEEP IN MIND – if you will be responsible for tail, the cost of same needs to be included in your calculation of the total
financial package that is being offered
© 2018 GARFUNKEL WILD, P.C.13GW www.garfunkelwild.com
CONFIDENTIALITY, RESTRICTIVE AND NON‐SOLICITATION COVENANTS
LET’S REMEMBER – THESE COVENANTS CAN BE ENFORCED!!!
And even if a court finds a covenant not to be enforceable as the limitations may not be reasonable, you may have to pay for
your own lawyer’s fees to get the benefit of such a ruling.• Confidentiality. Generally requires you to keep all information concerning the
employer confidential.
• Non‐Solicitation. Generally, requires you to not solicit patients, referral sources or other employees of the employer.
• Restrictive Covenant. Generally is described in the form of a radius from a certain location though occasionally may include prohibitions against working for specific competitors.
• Look at the radius on‐line – remember, radius is as the crow flies.
• What if the employer has multiple offices?
• What if the new employer has multiple offices?
© 2018 GARFUNKEL WILD, P.C.14GW www.garfunkelwild.com
WHAT TO ASK FOR ON CONFIDENTIALITY, RESTRICTIVE AND NON‐SOLICITATION COVENANTS?
• Confidentiality – add exceptions for previously known information
• Non‐Solicitation – family members, own referral sources, and patients one has treated
• Restrictive Covenant –• Lower the radius and time period
• Non‐applicable based on how agreement is terminated
• Non‐applicable for a certain probationary period
• Non‐applicable for certain other potential employers
© 2018 GARFUNKEL WILD, P.C.15GW www.garfunkelwild.com
THE TERM OF THE AGREEMENT – AND TERMINATION
• One can have a fixed term or a term that is not fixed. You caninclude automatic renewal terms.
• Bad Person Clauses. Make sure that notice and cure periods are included.
• Termination Without Cause. Very important to keep same inmind. It may not be a 5‐year contract.
• Add right to terminate if the employer breaches.
• How an agreement terminates may have consequences (e.g., enforceability of the restrictive covenant, unemployment insurance, etc.)
© 2018 GARFUNKEL WILD, P.C.16GW www.garfunkelwild.com
PARTNERSHIP?
Obviously only applies to private practices
• Unlikely that one will get an absolute promise but look for apromise to “talk” about it
• Know the practice• What is the structure? Who owns the real estate?
• Do your due diligence
• Speak to an accountant
© 2018 GARFUNKEL WILD, P.C.17GW www.garfunkelwild.com
CAN ONE BE AN INDEPENDENT CONTRACTOR?
• Usually, more of an issue for the employer
• The government views you as an employee
• Part‐time does not mean one is an independent contractor
• Disadvantages to employees include possibly more taxes and no benefits. But you may be able to deduct expenses
• There are compliance concerns under the Stark and Anti‐Kickback Laws
© 2018 GARFUNKEL WILD, P.C.18GW www.garfunkelwild.com
THE NEED FOR LEGAL ADVICE
• You need an expert in healthcare law – don’t ask a real estate lawyer
• There are costs involved – but they are relatively small incomparison to a multi‐year contract worth hundreds of thousands if not millions of dollars
• Even if you don’t get everything or anything you want in an agreement, you need to know what you are getting yourself into.
• Please – read your contract! It’s important!
NYCOMEC.org @NYCOMECCorp
PRESENTERINFORMATION
Alan Roth, D.O.
Biography:
10:25 a.m.
"Palliative Care:It's Always Too Early Until It's Too Late"
Alan R. Roth D.O., FAAFP, FAAHPM is Chairman of the Department of Family Medicine, Ambulatory
Care and Community Medicine at Jamaica Hospital Medical Center in Queens, NY. He is also Chief
of Palliative Care and Director of the Hospice and Palliative Medicine Fellowship Program and
former Family Medicine Residency Program Director. Dr. Roth, a graduate of NYIT College of
Osteopathic Medicine, is a practicing and academic Family Medicine and Palliative Care Physician
and the recipient of numerous “Best Doctor” awards. He is a Professor of Family Medicine at
NYITCOM and Assistant Professor of Social and Family Medicine at Albert Einstein College of
Medicine. Presenting and publishing widely over the course of his extensive career, Dr. Roth
consistently advocates for his patients and primary care values as a healthcare leader. He
currently serves as the Chair of the Primary Care Council of the Right Care Alliance. His
professional areas of interest are vast and include retaining a focus on patients during
healthcare transformation, teaching and integrative health.
Palliative Care:“It’s Always Too Early…….. ………..Until It’s Too Late”
Alan R. Roth DO, FAAFP,FAAHPMChairman Department of Family Medicine, Ambulatory Care
and Community MedicineProgram Director, Hospice and Palliative Medicine Fellowship
Clinical Professor of Family Medicine NYITCOM
I have no conflict of interest
Objectives
Review Basics of Palliative Care, Who isAppropriate for Palliative Care and Timing ofConsultation.
Discuss How to Explain Hospice and PalliativeCare to Patients and Families.
Demonstrate How to Collaborate with anMultidisciplinary Palliative Care Team.
Definitions
“The active total care of patients whose disease is not responsive to curative treatment. Control of pain, of other symptoms, and of psychological, social and spiritual problems, is paramount. The goal of palliative care is achievement of the best quality of life for patients and families.”
(WHO, 1990)
WHO‐Palliative Care: provides relief from pain and other distressing symptoms; affirms life and regards dying as a normal process; intends neither to hasten or postpone death; integrates the psychological and spiritual aspects of patient care; offers a support system to help patients live as actively as possible until
death; offers a support system to help the family cope during the patients
illness and in their own bereavement; uses a team approach to address the needs of patients and their
families, including bereavement counseling, if indicated; will enhance quality of life, and may also positively influence the course
of illness; is applicable early in the course of illness, in conjunction with other
therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.
Types of Palliative Care Medicine
Palliative Care Consultation Service
Ambulatory and Home Palliative CareServices
Dedicated Palliative Care Units in Hospitalsand Nursing Homes
Hospice Care‐ Inpatient, nursing home andhome
There is a Fate Worse than Death
To Live with Poor Quality of Life
To Live in Pain
To Suffer
To Be Alone
To Have Unfinished Business
To Live as a Burdon to Others
To Live without Dignity
Palliative Care
Specialized interdisciplinary health care
Progressive incurable terminal illness
Improve quality of lifePhysicalEmotional
SocialSpiritual
Alternative to Hospice
Restoring the Balance
Palliative Care
Life Prolonging Care
Patient
Clinical Information
Prognostication
Communication
Delivering Bad News
The GOC Family Meeting
Changing Goals of Care
Communication
Goals of Care Potential goals of care
Cure of disease
Avoidance of premature death
Maintenance or improvement in function
Prolongation of life
Relief of suffering
Quality of life
Staying in control
A good death
Support for families and loved ones
Routine outpatient visit, chronic life‐limiting disease(optimal), but …
Difficult to schedule sufficient time for thorough discussion
Difficult to anticipate all possible scenarios
Times of crisis;
Worst possible time to make difficult decisions
Usually when the “big” decision are actually made
When Should Goals Be Established?
Palliative Care Patients CHF, COPD, Cancer, etc. Expected prognosis <36 months HomeboundDeteriorating medical condition at risk for needing symptom management
Family conflicts Emphasis of care in the home setting 2 or more ED or Inpatient admissions in the last year
Functional or Performance Scale Score Low
PALLIATIVE CARE CONSULTATION CRITERIA
A. Primary Disease Process
□ Cancer ( Active / Metastatic / Recurrent)
□ Advanced COPD
□ Advanced CHF, EF < 25%
□ Cardio-Respiratory Arrest with Cerebral Hypoxia/ Anoxia
□ Shock (septic, etc.) with MODS
□ Advanced neurodegenerative disease ( Dementia, Parkinson’s , ALS)
□ ESRD and/or ESLD
□ Stroke (with at least 50% decreased functional ability)
□ Actively dying patient
PALLIATIVE CARE CONSULTATION CRITERIA
B. Concomitant Factors
□ Hemodialysis
□ Liver disease
□ Moderate CHF, CAD, Severe Valvular disease, Cardiomyopathy, Pulmonary HTN.
□ Bed Bound/Dysphagia/ Failure to Thrive/Functional Decline/ Pressure ulcers
□ Complex medical decision making. Pt/family disagreements about care or conflicts
□ Patients from Long Term Care Centers
□ Patients on home hospice
PALLIATIVE CARE CONSULTATION CRITERIA
C. Other Criteria to Consider The Patient is / has:
□ not a candidate for curative therapy
□ a life-limiting illness
□ unacceptable level of pain >24 hours
□ uncontrolled symptoms (i.e.dyspnea, nausea, vomiting, anxiety)
□ frequent visits to the Emergency Department
□ more than one hospital admission for the same diagnosis in last 30 days
□ prolonged ICU/ hospital stay without evidence of progress or improvement
□ transferred from ICU to floors and back to ICU
□ S/P Code 99/ Code 66.
□ Medical Futility
□ _________________________________________________________________________
PALLIATIVE CARE CONSULTATION CRITERIA
D. Call consult before discussions about:
□ PEG tube for artificial nutrition ( e.g. Pt with failed swallow test)
□ Tracheostomy for prolonged mechanical ventilation
□ Shiley or Permacath for HD
□ Withdrawal of ventilatory support
□ _________________________________________________________________________
“The Surprise Question”
Clinicians often will not identify patients withserious life threatening illnesses as terminal
When asked, “Is this patient dying?”
Most say, “No”
YET…
When asked, “Would you be surprised if thispatient died within the next year?”
Most say, “No”
How Palliative Care Can Help
Assessment and Management of Pain
Physical Symptom Control
Artificial Nutrition
Psychosocial issues
Assessing treatment goals
Communication/Family Conferences
Advanced Directives/DNR/DNI
Discharge Planning and Disposition
Timing of Palliative Care
“It’s always to early………….
……………….Until its too late”
Palliative Care:When should it be discussed?
Patients who experience difficult to treatsymptoms
Patients who fear future sufferingPatients who face uncertain medical choicesPatients who are imminently dyingAll patients with serious illness?Relieving pain and symptomsDiscussing hopes and fearsDiscussing prognosis
PrognosisImportant because enables better decisionmaking about care options
General physician bias – overly optimisticby 2 to 5 fold
Easier for some illnesses
Poor prediction skills may reflect educationaldeficiencies for clinicians
We MUST accept certain degree of prognosticuncertainty
Prognostication
The Disease
The Clinical Picture‐ History and Physical
Progression and Natural History ofCondition
PCP and Specialist Input
Prior Treatment Success/Failures
The Patients wishes and Goals of Care
MVA/Trauma/Homicide/SuicideCVA/MI/Cardiac Arrest
CHF/COPD/ESLD/ESRD
Cancer
/Dementia
PrognosticationGeneral Indicators of Health and Disease
General and Functional Assessment ScalesKarnofsky Performance Scale, PPS
Disease Specific ScalesDementia‐ FASTCHF‐ Seattle Heart Failure ModelCOPD‐ BODEESLD‐ MELDCancer ECOG and Disease Specific
Patients Wishes and GOC
Reasons Prognostication is Important
Its All About the Patient
Its All About the Family
Relationship Building
Goals of Care
Impacts almost every decision a patient makes
Cost Benefit Analysis
To Test or Not to Test?
To Treat or Not to Treat?
Communication of Bad News Communicating prognosis…
Some patients want to plan
Others are seeking reassurance
Tough questions:
“Am I dying?”
“How long do I have to live?”
…Communicating prognosis
Inquire about reasons for asking“Yes… but I don’t know when it will be”
“What are you expecting to happen?”
“What are your fears?”
“Are there things you need to finish before you die?”
“What experiences have you had with:others with same illness?
others who have died?”
…Communicating prognosis
Patients vary
“planners” want more details
those seeking reassurance want less
Avoid precise answers
hours to days … months to years
Remember, we are not good at this
Comparing Hospice vs. Palliative Care
Hospice
Prognosis of 6 months or less
Focus on comfort care
Medicare hospice benefit
Volunteers integral and required aspect of the program
Palliative Care
Any time during illness
May be combined with curative care
Independent of payer
Health care professionals
Challenges of the Hospice Discussion
Hospice requires a “bad news” discussion
Acceptance that medical treatment isn’t working
Acceptance of likelihood of death in 6 months
Giving up on hospitalization and disease‐driven treatment
Many patients don’t want to stop all treatment
May be willing to stop burdensome treatment
May want to continue to maintain more options
Small chances of cure or longer life maintain hope
Initially feels a lot like “giving up”
Palliative Care:Who should do it?
Primary Palliative Care • Basic pain and symptom management • Goals of treatment discussion • Discussion about resuscitation and invasive treatments • Responsibility of all clinicians (primary care and
specialty) Specialty palliative care • Complex pain and symptom management • Conflict around goals of care or treatments • Negotiation within families or between treating teams Quill TE, Abernethy AP. Generalist plus specialist palliative
Palliative Care Team
Hospice
41
Chronic disease or functional decline
Advancing chronic illness
Multiple co-morbidities, with increasing frailty
Death with dignity
Maintain & maximize health and
independence
Healthy and independent
Compassion, Support and Education along the Continuum
Advance Care PlanningAdvance Care PlanningTerminology of
Advance Directives Advance care planning
Process of discussion, documentation, implementation
Advance directives Instructional statement
living will
values history
personal letter
medical directive
MOLST/POLST Form
Proxy designation Health care proxy
Durable power‐of‐attorney for health care
Last StepsACP: Establish a specific plan of care expressed in medical orders using the POLST paradigm.
Adults whom it would not be a surprise if they died in
the next 12 months.
Next StepsACP: Determine what goals of treatment should be followed if complications result in “bad” outcomes.
Adults with progressive,life-limiting illness, suffering
frequent complications
First StepsACP: Create POAHC and consider when a serious, permanent neurological injury would change goals of treatment.
Healthy adults between ages 55 and 65 or at young age if diagnosed with a
serious illness
Stages of Advance Care Planning Over the Life Time of Adults
Medicare pays for ACP
Encounters must be face‐to‐faceconversations with the patient and/or theirsurrogate (patient does not need to bepresent)
99497 and 99498
Advance Care Directive does not have to becompleted but the documentation shouldrecord discussion of patient wishes aboutfuture medical treatment.
Palliative Care:Hoping and Preparing
“Lets hope for the best…” Join in the search for medical options Open exploration of improbable/ experimental Rx Ensure fully informed consent “…attend to the present…” Make sure pain and physical symptoms are fully managed Attend to depression and any current psychosocial issues Maximize current quality of life “...and prepare for the worst.” Make sure affairs (financial/personal) are settled Think about unfinished business Open spiritual and existential issues
NYCOMEC.org @NYCOMECCorp
PRESENTERINFORMATION
Ronald R. Burns, D.O.
Biography:
12:10 p.m.
"American Osteopathic Association (AOA)Update for Students and Residents"
An AOA board-certified family physician, Ronald R. Burns, D.O., serves on the board of the National
Board of Osteopathic Medical Examiners and is a member of the American College of Osteopathic
Family Physicians. He also is past president of the Florida Osteopathic Medical Association
(FOMA).
Dr. Burns has been an active member of the AOA Board of Trustees since 2007. He served as chair
of the Department of Business Affairs and received FOMA’s Physician of the Year award in 2002,
as well as its Distinguished Service Award in 2007.
Dr. Burns completed his osteopathic medicine degree from what is now the Ohio University
Heritage College of Osteopathic Medicine in Athens. Following completion of his degree, he
completed his postdoctoral medical training at the Doctors Hospital of Stark County in
Massillon, Ohio, and the Florida Hospital – East Orlando.
AOA VISION:Present and Future Directions
Ronald Burns, DOAOA President‐elect
NYIT COLLEGE OF OSTEOPATHIC MEDICINE
NOV. 28, 2018
Expanding Our PresenceOver 30 years, the number of DOs practicing in the US has more than tripled
145,000 DOs and osteopathic medical students in the US
115,000 DOs in the US 300% increase in 25 years
Strategic Focus
International Impact
Board Certification Member Value
Governance Alignment
Affiliate Alignment
SPECIALTY COLLEGES
OSTEOPATHIC ORGANIZATIONS
AOA: What We DO for YOU• Board Certification, OCC & CME
• Advocacy
• Career & Practice Success
• Public Awareness
• Lifestyle
AOA Certification International Impact
Focus Areas:Practice rightsMission/global healthAffiliate relationsResearchMedical school accreditation
Single Accreditation System Transition
72% of 1,244 AOA programs applied, transitioned, or accredited
193 have received or applied for Osteopathic Recognition
• Intentionally designed to preserve osteopathic identity and principles in GME
• AOA is committed to protect residents during the transition
• Revised Common Program Requirements recognize AOA
Single Accreditation System Transition
AOA Annual Research Grants
• Pre‐FY16 – $250,000 average• FY 2016 – $1.1M• FY 2017 – $1.3M• FY 2018 – $1.1M• FY 2019 – $1.4M
Research on Osteopathic Impact
Osteopathic Philosophy
Chronic Conditions
Musculoskeletal Injuries & Prevention
Pain Management
OMM/OMT
Student Grants – Building the PipelineGrantee Institution Title of Research Project
Kathleen Ackert, OMS‐II
Philadelphia College of Osteopathic Medicine
Leveling the Playing Field: Evaluating How Prerequisite Classes Affects Perceived Stress Levels in Medical Students
Katrina Bantis, OSM‐II
NYIT COM The Cardioprotective Benefits of Prolonged Fasting
Kate Slaymaker, OMS‐II
Edward Via College of Osteopathic Medicine ‐Virginia Campus
Inviting Interdisciplinary Input: An Osteopathic Approach to Leveraging Community Support for Prevention and Management of Chronic Disease in Rural and Appalachian Virginia
Brand Awareness
648,291 Find Your DO Profile Views 1.08 BILLION ad impressions
A Voice in Health Care
Opportunities abound! Family Unity
THERE IS NEVER A BETTER TIME TO BE A DO …
THANK YOU!
NYCOMEC.org @NYCOMECCorp
PRESENTERINFORMATION
Philip Volpe, D.O.
Biography:
1:00 p.m.
"Personal Experiencesand Lessons Learned in Combat"
Major General Philip Volpe retired from the United States Army after 30 years of distinguished
service, in 2013. His final duty assignment was as the Commanding General at the Army Medical
Department Center and School in San Antonio, Texas, where he led and managed education,
training, and leader development for all of Army Medicine. He currently serves as assistant
professor at the Kansas City University of Medicine and Biosciences, and also provides services
as an independent health care and leadership consultant. After graduating from NYIT College of
Osteopathic Medicine, he became a board-certified family physician. He participated in
numerous combat deployments and has been awarded the Defense Superior Service Medal,
Bronze Star, Purple Heart, and Army Commendation Medal with “V” Device for Valor. Dr. Volpe
was selected as the Military Family Physician of the Year in 1996 and served as co-chair of the
Department of Defense Task Force on the Prevention of Suicide by Members of the Armed
Forces from 2008-2011.
Personal Experiencesand
Lessons Learnedin
Combat
NYCOMEC Grand Rounds
28 November 2018
Philip Volpe, DOFamily Medicine
Major General, United States Army (Retired)
Objectives
Share lessons about medical practices which enhance pre-hospital survivability.
Share lessons about medical and public health factors which reduce morbidity and mortality.
Share personal stories of the heroic actions of our wounded warriors; as well as some of the successes & failures as a physician.
LESSONS LEARNEDTraining and preparation reduces
morbidity & mortality!
Train; Rehearse; Repeat
Field Sanitation & Hygiene
Nutrition & Water
Sleep Discipline & Rest
Lesson #1
Lesson #2Prevention trumps treatment!
Lesson #3Everyday conditions occur every day!
Lesson #4Safety and discipline keep people alive!
Lesson #5
Triage requires expertise & practice!
Lesson #6Triage is temporary and it’s fluid!
Lesson #7
First … STOP Hemorrhage!
Lesson #8Small wounds; bad injuries!
Improvise, if you must!Lesson #9 Lesson #10
Humans are the best blood bank!
Lesson #11Leave tissue on & don’t close wounds!
Lesson #12Think compartment syndrome!
Lesson #13Physician resiliency is essential!
The Top Advancements resulting from the Battle of Mogadishu
Critical Care Aeromedical Transport TeamsModern TourniquetsTC3 – Tactical Combat Casualty CareBody ArmorShock Management Protocols/GuidelinesHemostatic DressingsOver-pressure Hearing ProtectionBlood Product Administration & Rapid Testing
QUESTIONS?
NYCOMEC.org @NYCOMECCorp
PRESENTERINFORMATION
Zeynep Sumer King, M.S.
Biography:
2:05 p.m.
"Practical Approaches for Clinicians to Lead and Engage in Quality and Patient Safety"
Zeynep Sumer King joined Greater New York Hospital Association (GNYHA) in 2006. She is responsible for leading a number quality initiatives and assisting members on quality improvement, health information technology, and health care workforce issues. Prior to joining GNYHA, Ms. Sumer King worked for IPRO, the quality improvement organization for New York State, under a quality improvement contract with the Centers for Medicare & Medicaid Services. She holds an M.S. in Health Communication from Tufts University School of Medicine and a B.A. in Communications from Michigan State University.
NYCOMEC.org @NYCOMECCorp
PRESENTERINFORMATION
Biography:
2:05 p.m.
"Practical Approaches for Clinicians to Lead and Engage in Quality and Patient Safety"
Hillary Jalon has worked at NYC Health + Hospitals since September 2016 and is currently Assistant Vice President for Quality & Safety in the Office of Quality & Safety for the System. In this role, she is responsible for designing and implementing tiers of quality improvement training for the clinical and non-clinical workforce, as well as working with leadership to define priorities for the Quality Assurance and Performance Improvement Quality Committee to the Board. Ms. Jalon is currently an Adjunct Assistant Professor of Health Policy and Management of NYU’s Robert F. Wagner Graduate School of Public Service for the Continuous Quality Improvement course. Previously, Ms. Jalon was employed at the United Hospital Fund (UHF) for over 11 years, most recently as Director of Quality Improvement, being responsible for providing strategic direction of UHF’s quality initiatives. She was also a member of the New York State Department of Health’s Hospital-Acquired Infection Technical Advisory Workgroup. Prior to joining UHF, Ms. Jalon was employed at New York-Presbyterian Hospital for over six years, in several roles, including as Manager of Service Improvement and Performance Improvement Specialist.
Hillary Jalon M.S.
Practical Approaches to Engage Clinicians in Quality
Improvement
Hillary Jalon, NYC Health + HospitalsZeynep Sumer King, GNYHA
Presentation to New York College of Osteopathic Medicine Educational Consortium
November 28, 2018
Today’s Objectives*
1. Describe why engaging the healthcare workforce in quality improvement is important
2. Compare the fundamental differences between Quality Assurance and Quality Improvement
3. Describe how to use a sub-set of common quality improvement tools
4. Explain the basics of how to use a quality improvement methodology, like the Model for Improvement
5. Define common challenges in quality improvement and potential ways to overcome those them (we won’t go through this objective—slides are included at the end for you to review on your own)
*Attribution goes to the GNYHA/United Hospital Fund Clinical Quality Fellowship Program for using a sub‐set of slides from a “Tools in Quality Improvement” presentation from that program. Other attribution given throughout the presentation.
Objective 1. Describe why engaging the healthcare workforce in quality improvement is important
What’s wrong with care?
Amount spent versus outcomes
Errors –Unsafe care
Overuse/underuse
Not aligned with patient needs, less thansatisfactory patient experience
5
Florence Nightingale Ernest Armory Codman 1820-1910 1869-1940
Nurse, active in philanthropy,ministering to the ill and poor
Early innovator in patient safety –harm prevention
Organized a team of 34 nurses to tend to fallen soldiers in Crimean War Unsafe, unsanitary conditions
Her work with the team reduced the hospital’s death rate by two-thirds
Wrote a book analyzing her experience Proposed reforms for other military
hospitals
• Surgeon• Founder of Outcomes
Management• Lost privileges at Mass General
due to “radical” plan to monitor surgeon competence
• Established his own hospital to pursue performance improvement
*Attribution goes to the GNYHA/United Hospital Fund Clinical Quality Fellowship Program and Steven Kaplan, MD, for using this slide.
Pioneers in Quality…
Preventable adverse events…
Rarely due to just one individual
Multiple failures
Complex, time pressured work environments inhealthcare
Normalization of deviancy
Consistent “Work arounds” in healthcare
Institute of Medicine (IOM): To Err is Human (1999) Harm caused by medical care
At least 44,000 and potentially as high as98,000 die in the US annually due to medical errors
More than for traffic accidents, breast cancer
Medications – 7,000 deaths
Improve by: Systems (not individuals)
Reporting
Learning from events (not solely training)
Six Domains described:• Timely• Effective• Safe• Patient centered• Equitable• Efficient
IOM: Crossing the Quality Chasm (2001)
How do We Get There? Key Components Value
Data Transparency
Measurement
Improvement We will be talking about this today
System, Provider, Patient engagement
Objective 2. Compare the fundamental differences between Quality Assurance and Quality Improvement
Quality Assurance vs. Quality Improvement
Providing the right care, to the right patient every time
*Attribution goes to David Koterwas, NP at NYC Health +Hospitals/Bellevue for using this slide.
Quality Assurance vs. Quality Improvement
• Key processes in how we improve the care that we
deliver and how we maintain these changes
• Closely linked, integrally connected, but different in
approach
*Attribution goes to David Koterwas, NP at NYC Health + Hospitals/Bellevue for using this slide.
Quality Assurance Quality Improvement
Goal Monitoring and ensuring compliance with a previously
determined metric or standard
Continuously evaluating systems and processes to
deliver the best care possible
Orientation Reactive, typically mandated Proactive, guided by gaps
Focus Outliers, “fall-outs”, individuals
Processes and systems
Responsibility Specific committee or appointed group
Staff involved in the process at every level
Scope Individual healthcare provider
Patient care process
Who initiates and leads Leadership Frontline staff
Time frame Prescribed and typically static
Continuous and evolving
Attribution goes to Eric Wei, MD, MBA, Chief Quality Officer at NYC Health + Hospitals, for this slide.
Foundational Differences Between Quality Assurance and Quality Improvement: A Primer
Quality Assurance frequently drives Quality Improvement efforts (example)
Quality Assurance Quality ImprovementMonitor Flu vaccinations Rates in comparison to local standards
Develop an initiative to:• Identify process and individualbarriers to obtaining flu vaccinations
• Develop alternative processes to provide improved access
• Develop inservicing programs to overcome individual barriers
• Continuously evaluate where processes fall short when ratesdecrease and address them by engaging in tests of change to improve them
*Attribution goes to David Koterwas, NP at NYC Health + Hospitals/Bellevue for using this slide.
Objective 3. Describe how to use a sub-set of common quality improvement tools
Assesses a problem orarea you think needsimprovement Narrows down on an
issue Identifies improvement
priorities Engages teams to
focus on improvement We’ll only discuss a
sub-set of commonlyused tools today
Why Use Quality Improvement Tools?
www.ihi.org
BrainstormingAn activity (formal or informal) in which people put forward any idea(s) that occur to them at the moment • No ideas should be judged or perceive negatively• The more ideas, the better
The group may re‐consider the ideas, make decisions about their relevance and importance, and prioritize them.
Three Potential Tools for Problem Analysis
Fishbone Diagram
Pareto Chart
Flow Chart
What are the possible causes of the problem at your health care
organization?
Where should your health care organization’s team focus its
energies and limited resources to address the problem?
What is the current process? Can the team learn from this, and
eventually design a flow to reflect an ideal state?
Effect orProblem
People(Manpower)
Procedures(Materials)
Policies(Methods)
Plant(Machinery)
Source: Kelly, D. L. 2006. Applying Quality Management in Healthcare, 2nd Edition. Chicago: Health Administration Press. Reprintedwith permission.
Cause
Tip: Don’t get stuck on the # of bones! Can
have more, but probably not less than 4.
Fishbone DiagramAKA: Ishikawa or Cause and Effect Diagram
A visual tool to help identify the cause and effect of a problem
Cause
Cause CauseKey Points:
• Cause and Effect
• Name the problem, organize reasons for the problem in categories (e.g., people, policies, procedures, plant, systems, environment)
Attribution to New York‐Presbyterian Hospital for this as well as Karen Scott, MD.
Example of Fishbone – Possible Causes of All-Cause Readmissions
Example of Fishbone – Possible Causes of Surgical Site Infections (SSIs)
Patients Equipment Procedure/Technique
Environment Clinical Decisions
SSIsCulture
Age
Pressure ulcer
Diabetes/glucose levels
Compliance
Diagnosis/ disease
Comorbidities
Nutrition/diet
Surgical equipment
OR cleaning solutions
Bed type
Wound care materials
OR cleaning process
Procedure type
Surgical technique
Aseptic practice
Hair removal
Patient hand-off Communication
Pre-op and Post-op education
Intra/Post-op Pt. temp
Wound care technique
Providers/Staff
OR air filter maintenance
OR cleaning crew
Post-op recovery location
PACU traffic
Shift change
Surgical team consistency
OR temperature
OR traffic
Inpt room traffic
Staff changes
Surgical fellowship turnover
Multiple patients in case load
Inadequate aseptic technique
Nurse/Surgeon/ Anesthesiologist
Lack of awareness
Post-op medications
Post-op discharge follow-up
Dressing change
Post-op antibiotics
Wound care
Antibiotic selection & administration
Repeat antibiotic
Pre-op antibiotic
Post-op glucose
Pre-op pain mgmt
Central line
Time-out procedurePost-count debrief with OR team
Modified from Joint Commission’s Center for Transforming Healthcare, Cleveland Clinic Surgical Site Infection InitiativeUsed in a GNYHA/HANYS NYS Partnership for Patients conference, 2013.
Pareto Chart
• Graphically demonstrates the relative importance ofproblems
• Based on the proven “Pareto” principle: 20% of thesources cause 80% of any problem
• Focus on key problems that offer the greatestpotential for improvement
• Helps prevent shifting the “problem” to where the“solution” removes some causes but worsensothers and does not fix the problem
Example of Pareto: Reasons for Canceled Clinic Appointments
Run Chart
Graphical display of data plotted in some type of order Studies how a process changes over time
Helps us learn about performance of a process with minimal complexity
Displays data to make process performance visible
Determines if changes tested result in improvement
Determines if we are holding the gains made by our improvement
Constructing a Run Chart
Horizontal axis is typically time scale (e.g., days,weeks, months, quarters)
Could also include sequential patients, visits orprocedures
Vertical axis represents the quality indicator beingstudied (e.g., infection rates, patient falls, readmissionrates)
Run Chart Example: Number of Unreconciled Medications
Weeks Monitored
Control Chart
Constructing a run chart is the first step to developing a control chart
Control charts build on run charts and are a key tool used to display variation in the process Similar to run chart, studies how a process changes over time
Includes an upper line for the upper control limit and a lower line for the lower control limit Lines are determined from historical data
By comparing current data to the upper and lower lines, you can draw conclusions about whether the process variation is consistent (in control) or is unpredictable (“out of control,” affected by special causes of variation)
Determine if a process is stable http://asq.org/
Control Chart Example: Number of Unreconciled Medications
(control chart)
Weeks Monitored
Circled points are “out of control” points—find out, what happened during these times?
New residents come in during Week 8
Staffing change, with nurse on leave in during Week 19
Objective 4. Explain the basics of how to use a quality improvement methodology, like the Model for Improvement
Improvement Methods: Execution
Improvement is a science Defined methods Data driven Variety of methodologies Tools (some described in Objective 3) Qualitative as well as quantitative methods for
measurement Interdisciplinary approach is critically important
(clinical, administrative, social, systems)
Several improvement methods, one is notbetter than another
Some Improvement Methods, Common Objectives
CHARACTERISTICS PDSA* SIX SIGMA LEAN
Structured problem-solving methodology X X X
Solutions aimed at minimizing / eliminating root causes of problems
+/- X X
Rapid experimentation or tests of solutions on a small scale prior to spreading widely
X +/-
Metrics selected and data collected to measure whether an improvement has been made
X X X
Improvement requires a continuous cycle of adjusting the process to enable improved results
X
Empowerment of front-line staff to manage the sustainment of improvements
X X X
*PDSA=Plan‐Do‐Study‐Act, using the Institute for Healthcare Improvement’s Model for Improvement
*Attribution goes to Karen Scott, MD for using this slide.
The Model for Improvement
• What are we trying to accomplish?
• Team Aims
• How will we know that the change is an improvement?
• Measurement
• What changes can we make that will result in an improvement?
• Tests of Change/Interventions
Source: www.ihi.org
Developing an AIM Statement
State Aim clearly Describe what needs to be improved
Include numerical goals Helps to create need for change and directs measurement
Set stretch goals, BUT don’t be too ambitious Communicates that maintaining status quo is not an option
Be prepared to refocus the Aim if your team finds it isunrealistic Keep within a manageable scope Focus on a smaller part of issue Be realistic!
Avoid “Aim Drift” Make sure you don’t slip back on your goals; continue to repeat Aim
http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementTipsforSettingAims.aspxAccessed on January 12, 2018
Aim Statement Example: What are We Trying to Accomplish?
Reduce 30-day all cause preventable readmissionrates at Hospital A+.
Reduce 30-day preventable readmission rates by5% over the next 12 months for patients withcongestive heart failure on 5 West unit at HospitalA+.
Thoughts? What can be improved?
How Will We Know that the Change is an Improvement? Measurement
Substantiates need for change Demonstrating performance gap overall Demonstrating variability in performance
Designed to help your improvement team learn and establish improvement priorities
Like a growth curve: it’s not where you are, but where you are going
Answers the question: Are changes an improvement?
IS NOT: Designed for criticism or punishment Supposed to end (it should be sustainable)
Types of Measures1. Outcome Measures
Results in performance attributable to testing or implementing an intervention
How is the health of the patient affected? EXAMPLES: Number symptom free days for asthma patients Emergency Department asthma visits
2. Process Measures Steps in a process that lead to a change (either positive or
negative) to an outcome measure EXAMPLE: Number of patients with Asthma Action Plan
3. Balancing Measures Measures unintended consequences of change(s) in the system
expected, or not EXAMPLE: Cycle Time
*Attribution goes to Melissa Lee, MD at NYC Health + Hospitals/Kings for using example measures.
What Changes Can We Make that will Result in Improvement? PDSA Cycles
Making small changes over a short period
of time to test if the change works
PDSA=Plan, Do, Study, Act
Plan: identify the change you want to make
Do: make the change
Study: it for a pre-set period of time
Act: on the change, keep it, refine it, or drop it
Onto the next change or stepSource: www.ihi.org
Tips To Consider When ConductingSmall Tests of Change
1. Plan multiple cycles for a test of a change2. Scale down the size of the test (the number of patients or
location)3. Test with volunteer staff or clinicians 4. Do not try to get complete consensus during tests5. Be innovative to make the test feasible6. Collect useful data during each test 7. Test over a wide range of conditions, and try a test quickly
Source: www.ihi.org
Run Chart Example Corresponding with Tests of Change
Percent of Patients with Planned Care Visits
0%10%20%30%40%50%60%70%80%90%
100%
Janu
ary
Febru
ary
Mar
chApr
ilM
ayJu
ne July
Augus
t
Septe
mbe
r
Octob
er
Novem
ber
Decem
ber
Tried encounter forms
Nurse Smith left
GOAL
Tested Change of developing registry
*Fictitious data *Attribution goes to Karen Scott, MD for using this slide.
Quality Improvement Project Example*
What are we trying to accomplish? (Aim): Expedite medication refill process for stable patients in an internal medicine clinic to save 20 hours of provider time to spend on unstable patients within the next 6 months.• Why is this important?
– Improves: access to care; clinic efficiency; patient/family experience with care; clinician satisfaction
– Organizational imperative/executive leadership support– Part of Patient Centered Medical Home certification
How will we know that a change is an improvement? Stable patients will receive medication in a timely manner Provider-patient time saved Measures to be collected: Number of stable patients receiving refills without a Primary Care
Physician (PCP) visit Patient Experience (ease of getting refills w/o seeing PCP)
*Attribution goes to Amanda Ascher, MD; this was a project she led with an interdisciplinary teamduring her time in the GNYHA/United Hospital Fund Clinical Quality Fellowship Program.
Quality Improvement Project Example (continued)
What changes can we make that will result in an improvement? New expedited refill process tested on one PCP first
• Nurse and clerk engaged in understanding expedited refill process• Stable patients and their caregiver inserviced about how to expedite
medication process by nurse and clerk• Patient/caregiver tells clerk if refill is needed
Results from initial test: 30 initial patients received expedited medication refills (versus 0
at baseline) 10 hours of provider-patient time saved** Improved experience with ease of getting refills: 20%
Good/Excellent at baseline vs. 56% after intervention implemented
Wound up being sustainable in internal medicine and spread toGYN service
Model spread to other clinics and services
**based on an average of 20 minutes face time per visit with PCP.
*Attribution goes to Amanda Ascher, MD; this was a project she led with an interdisciplinary teamduring her time in the GNYHA/United Hospital Fund Clinical Quality Fellowship Program.
Objective 5. Define common challenges in quality improvement and potential ways to overcome them (we won’t go through this—included for you to review on your own)
Common Challenges in Quality Improvement…
Challenge/Barrier Examples Suggested Solutions
Lack of leadership commitment
• Try to identify: Who drives quality in your organization? Who overseesquality improvement at the leadership level?
• With leadership identified, try to identify and set realistic, achievable quality improvement goals.
Lack of participation by clinical or front line staff: fear of change
• Identify clinicians and administrative personnel with energy and interest in making change.
• Set common goals with team; this will help them understand quality improvement impact.
• Continuously engage leadership to encourage accountability and obtain their buy-in to provide support.
Lack of resources to supportquality improvement (Material, Human, and Time)
• Present your progress to leadership to show that what you are doing ishaving an impact.
• Before asking leadership for new resources (human or equipment), examine current process, analyze data, initiate tests of change—don’t just jump to “no resources” mentality.
Failure or inability to link quality improvement efforts with costs
• Try to make the business case for quality improvement (see example onnext page).
• Obtain support from the Chief Financial Officer, if possible.
Common Challenges in Quality Improvement…(continued)
Challenge/Barrier Examples Suggested Solutions
Scope too large/Lack of Clarity or Focus
• Focus on 1-2 aspects at first; keep focus narrow at first; conduct small tests.
• Set aside other aspects of project until you have a grasp on primary focus.• Too many priorities puts you at risk for, ”this is the flavor of the month.”
Think through small tests within 1 or 2 areas of focus first.
”Scope Creep” • If new or too many topics are identified by team, eventually spin off sub-groups.
• Stay on track with primary focus at first.
Flawed Measurement Systems, Inaccurate or unavailable data
• Try to identify something measurable, using small amounts of data at first; if you get hung up on “big data” or a complicated measurement strategy, you will not move forward.
• Before jumping into something, think through: How will we measure success?
• Continue to refine your data collection process.
Common Challenges in Quality Improvement…(continued)
Challenge/Barrier Examples Suggested Solutions
Perverse regulatory, reimbursement incentives
• Keep the momentum by focusing on, “This is what we need to accomplish to improve patient care and outcomes.”
• Your team can identify areas of focus that impact the regulatory environment, while improving patient care (e.g., hospital-acquired condition reduction efforts, Delivery System Incentive Reimbursement Payment program priorities, etc.)
Sustainability, Holding Gains in Quality Improvement (this is the #1 challenge in quality improvement!)
• Team gets focused on other priorities. Make sure this effort is an imperative of leadership and that you have buy-in from the team. That is the surest way to sustain and spread gains.
Remember…
Improvement is a science There are defined methods It should be data driven There are a variety of methodologies Many tools can be used in improvement science,
and only a subset were described today Qualitative as well as quantitative methods for
measurement Interdisciplinary approach is critically important in
improvement (clinical, administrative, social, systems)
Not one improvement methodology is better thananother!
Questions?
Contact information:
Hillary Jalon, Assistant Vice President, Quality & Safety, NYC Health + Hospitals
[email protected], 212-788-5443, or 646-456-4155
Zeynep Sumer King, Vice President, Regulatory and Professional Affairs, GNYHA
[email protected] or 212-258-5315
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2018 NYCOMEC Board of Directors
Chairman of the BoardJerry Balentine, D.O.
Secretary
Robert Yost, M.S.
President / CEODavid Broder, D.O.
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Jerry Balentine, D.O.
NYCOMECPresident
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David Yens, Ph.D.
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