Problem: Given the United States’ urgency for systemic-level improvements to care, advancing systems-based practice (SBP) competency among future physicians is crucial. However, SBP education is inadequate, lacks a unifying framework and faculty confidence in its teaching, and is taught late in the medical education journey.
Approach: The Oklahoma State University Center for Health Systems Innovation (CHSI) created an SBP program relying on Lean Health Care for a framework and targeted medical students before their second year began. Lean curricula were developed (lecture and simulation) and a partnership with a hospital was secured for work-based practice. The CHSI developed a skills assessment tool for preliminary evaluation of the program. In June 2022, 9 undergraduate medical students responded to a Lean Health Care Internship (LHCI) presentation.
Outcomes: Student SBP skills increased after training and again after work-based practice. All 9 students reported that their conceptualization of problems in health care changed “extraordinarily,” and they were “extraordinarily” confident in their ability to approach another health care problem by applying the Lean method. The LHCI fostered an awareness of physicians as interdependent systems citizens, a key goal of SBP competency. After the internship concluded, the Lean team recommendations generated a resident-led quality assurance performance improvement initiative for bed throughput.
Next Steps: The LHCI was effective in engaging students and building SBP skills among undergraduate medical education students. The levels of student enthusiasm and skill acquisition exceeded the Lean trainers’ expectations. The researchers will continue to measure LHCI’s effect on students’ rotation experiences to better evaluate the long-term benefit of introducing SBP concepts earlier in medical education. The program’s success has spurred enthusiasm for continued collaboration with hospital and residency programs. Program administrators are exploring how to broaden access.
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Forging compromiso after the storm: activism as ethics of care among health care workers in Puerto Rico, Critical Public Health
Puerto Rico was hit by a category 4 hurricane that severely damaged power,
water, and communications systems on the 20th of September 2017. Based
on 56 qualitative interviews, this article documents how health care workers
created a new ethics of care after Hurricane Maria and engaged in novel
forms of health activism to both repair past damage and imagine a different
future. Many doctors, nurses, and other health care professionals went to
work after the storm treating patients, fixing their workplaces, and resolving
logistical problems. Health care workers responded emotionally to the
event by finding meaning and purpose in their work, forging a sense of
solidarity, and valuing their ability to help others. Our respondents used the
term compromiso to describe their determination and sense of purpose, and
we borrow this term to label the specific ethics of care generated from their
experiences after Maria.
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- NSF-PAR ID:
- 10315269
- Date Published:
- Journal Name:
- Critical public health
- Volume:
- 31
- Issue:
- 2
- ISSN:
- 0958-1596
- Format(s):
- Medium: X
- Sponsoring Org:
- National Science Foundation
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Abstract Objective Many policymakers and advocates assume that directed and query-based health information exchange (HIE) work together to meet organizations’ interoperability needs, but this is not grounded in a substantial evidence base. This study sought to clarify the relationship between the usage of these 2 approaches to HIE.
Materials and Methods System user log files from a regional HIE organization and electronic health record system were combined to model the usage of HIE associated with a patient visit at 3 federally qualified health centers in New York. Regression models tested the hypothesis that directed HIE usage was associated with query-based usage and adjusted for factors reflective of the FITT (Fit between Individuals, Task & Technology) framework. Follow-up interviews with 8 key informants helped interpret findings.
Results Usage of query-based HIE occurred in 3.1% of encounters and directed HIE in 23.5%. Query-based usage was 0.6 percentage points higher when directed HIE provided imaging information, and 4.8 percentage points higher when directed HIE provided clinical documents. The probability of query-based HIE was lower for specialist visits, higher for postdischarge visits, and higher for encounters with nurse practitioners. Informants used query-based HIE after directed HIE to obtain additional information, support transitions of care, or in cases of abnormal results.
Discussion The complementary nature of directed and query-based HIE indicates that both HIE functionalities should be incorporated into EHR Certification Criteria.
Conclusions Quantitative and qualitative findings suggest that directed and query-based HIE exist in a complementary manner in ambulatory care settings.
- Free Publicly Accessible Full Text
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Accepted Manuscript1.0
- Journal Article:
- https://doi.org/10.1080/09581596.2020.1846683
