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ForwardThe Best Care Possible: Clinical and Cultural Leadership for the 21st Century 10.23.19
Brief Abstract Listing Description of Presentation:
Everybody wants the best care possible for their loved ones and themselves through the very end of life. Of course, that phrase means different things to different people. Delivering the best care possible, therefore, requires access to a broad array of services and coordination among providers, patients and their families. This presentation will explore the elements that must be in place within and beyond health care and the stakeholders who must be in communication to reliably provide care that is consistent with best practice standards and with the personal preferences of patients and families.
Target Audience
All Staff of UPMC
Learning Objectives
- Discuss the fundamental components of quality clinical care in the context of serious illness.
- Describe the elements and process of shared decision-making
- Identify the Structure, Process, Outcome approach to quality improvement
- Describe the role of individuals and their families as engaged effective partners in the shared goal of achieving optimal care.
- Distinguish the nature of illness as personal, rather than purely medical.
- Summarize the concepts which define dying as a critical time in the lives individuals and families – and examine the opportunities within these difficult times.
- Describe the Institute for Human Caring – and the Non-Incremental Change Package
Objectives
| Content Outline | Time Frame | Presenter | Teaching Methods |
At the end of this activity the learner will be able to: | Provide an outline of the content for each objective. Number each content area with corresponding objective. | State the time frame (in minutes) for each Objective
| List speakers’ names | Describe the teaching strategies. |
| Care of chronically and incurably ill patients is of low quality and high cost. Medical practice often conflates disease treatment with patient care. A public health crisis surrounds chronic illness and dying in America.
The frame shift from approaching serious illness as if it were solely medical to seeing illness and dying as fundamentally personal – and only partly medical – is essential to understanding the opportunity within this crisis. Change is necessary – and urgent. | All times are approximate.
15 | Ira Byock, MD, FAAHPM Founder and Chief Medical Officer, Institute for Human Caring, Providence Health and Services, and Professor of Medicine and Community & Family Medicine Geisel School of Medicine at Dartmouth
| Didactic lecture, clinical narratives and PPT.
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| In “Crossing the Quality Chasm” (2001) The Institute of Medicine provided six categories for quality care:
This new taxonomy of high quality also gives us a contrasting taxonomy for low quality care, or in plain-speak, bad care.
A definition and relevant examples of bad care will be presented – with emphasis on care that is not aligned with either achievable physical and functional outcomes or individual patient’s values, preferences, and priorities.
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| We all want to provide the best care possible to patients and their families. That includes taking full advantage medical science and disease treatments, as well as providing optimal personal care.
Shared decision-making enables us to personalize care. Patients and families are expert in their values and preferences. Professionals are expert in medical and nursing science, and the ins and outs of our complex health care system. Together they can identify what is the best care for the person who is frail or ill at this point in time.
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| In focusing on patients with advanced illness the three key parameters of health system worth are well aligned: Access to services, Quality of care, and Costs - The Value Equation. Donabedian introduced Structure, Process, Outcome paradigm of quality improvement Palliative care is one example in which quality and costs align. Additionally, we now know that palliative care can improve quality of life AND length of life.
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| The pivotal role individual values and preferences of the people we serve will be described. Advance Directives will be discussed, including what they are and what they aren’t.
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V. Distinguish the nature of illness as personal, rather than purely medical. Summarize the concepts which define dying as a critical time in the lives individuals and families – and examine the opportunities within these difficult times. | Current cultural attitudes around dying include: Americans’ avoidance of the subject, and cultural confusion regarding morally wholesome modes of dying. Families commonly share the experiences of illness with people who are sick However, the continued opportunities for growth and development at this important time in the life of the person and his or her family will also be highlighted. Incurable illness offers the following opportunities:
For families, there are opportunities to complete relationships, honor people’s inherent dignity, and celebrate those we love during their last days.
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VI. The Institute for Human Caring – and the Non-Incremental Change Package | Elements of Non-Incremental Change Package include:
Highlights of this model include: recent Epic optimization and 2016 Providence Health Incentive plan | 15 |
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Disclaimer Statement
The information presented at this CME program represents the views and opinions of the individual presenters, and does not constitute the opinion or endorsement of, or promotion by, the UPMC Center for Continuing Education in the Health Sciences, UPMC / University of Pittsburgh Medical Center or Affiliates and University of Pittsburgh School of Medicine. Reasonable efforts have been taken intending for educational subject matter to be presented in a balanced, unbiased fashion and in compliance with regulatory requirements. However, each program attendee must always use his/her own personal and professional judgment when considering further application of this information, particularly as it may relate to patient diagnostic or treatment decisions including, without limitation, FDA-approved uses and any off-label uses.
Ira Byock, MD, FAAHPM
Founder and Chief Medical Officer Institute for Human Caring
Disclosure Statement
No members of the planning committee, speakers, presenters, authors, content reviewers and/or anyone else in a position to control the content of this education activity have relevant financial relationships with any entity producing, marketing, re-selling, or distributing health care goods or services, used on, or consumed by, patients to disclose.
In support of improving patient care, the University of Pittsburgh is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician (CME)
The University of Pittsburgh School designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Other health care professionals will receive a certificate of attendance confirming the number of contact hours commensurate with the extent of participation in this activity.
Available Credit
- 1.00 AMA PRA Category 1 Credit™The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
- 1.00 Attendance