Handout 5.1 Developing a Refined Improvement Goal ETHICS ISSUE 1: Shared Decision Making with Patients—Advance Care Planning 1. Ethics Issue 2. Ethical Standard Source(s) 3. Ethical Standard Description(s) with 4. Best Practice “Should” 5. Metric 6. Current Ethics Practice “Is” 7. Reality Check 8. Achievable Goal 9. Refined Improvement Goal A recent review of care health records found that only a few patient requests for assistance with completing an advance were followed up on by clinic staff. VHA Handbook 1004.2 Care Planning and Management of Advance VHA Handbook states that information about advance directives and/or in completing the forms must be provided for all patients who request this service. Exclusion(s): Patients who change their minds about their requests for assistance, who withdraw from the Health Care System, or who now lack Primary care patients who request with completing an advance directive should it [unless change their minds about their requests for assistance, withdraw from the Health Care System, or who now lack Numerator: The number of primary care provided with assistance as measured by a note template completed by a social worker or someone equally trained ____________ Denominator: Total number of primary care who requested with completing an advance directive Method: Record review Sample size: 30 Time frame for data collection: 1 week Current ethics practice was determined based on a of 30 primary care patient health records. Currently, 10% of primary care patients who have a request for assistance with completing an advance directive it. 1. Starting Point 2. Seriousness 3. Environment 4. Challenge
MODULE 2 MODULE 3 MODULE 4 MODULE 5 ETHICS ISSUE 2: Professionalism in Patient Care—Truth Telling 1. Ethics Issue 2. Ethical Standard Source(s) 3. Ethical Standard Description(s) with Exclusions 4. Best Practice “Should” 5. Metric 6. Current Ethics Practice “Is” 7. Reality Check 8. Goal 9. Refined Improvement Goal The quality manager for surgical found a number of in which adverse events that caused harm should have been disclosed to patients or personal were not disclosed. VHA 1004.08 Disclosure of Adverse Events to Patients There is an ethical obligation to to patients harmful adverse events that have been sustained in t he course of care, including cases where the harm may not be obvious, or where there is potential for harm to occur in the future. Exclusion(s): Patient is incapacitated, or otherwise unable to take part in the pro-cess, and there is no representative. Adverse events that cause harm to patients on surgical should be disclosed to the patient or personal representative [unless patient is deceased, incapacitated, or otherwise unable to take part in the and there is no personal Numerator: Number of events that caused harm to patients that were to patients or personal representatives ____________ Denominator: Total number of adverse events that caused harm to patients on surgical Method: Record review Sample size: 100% Time frame: Past 6 months Current practice was determined by identifying all adverse events that caused harm to patients on surgical services over the past 6 months through a review of incident reports. The of these patients were reviewed for a disclosure note. Currently, 65% of adverse events that cause harm to patients on surgical services are being disclosed to or personal representatives. 1. Starting Point 2. Seriousness 3. Environment 4. Challenge
► Challenge 5. What achievable goal would challenge the team? NOTE: A stretch or challenge goal counteracts the tendency to “just do that much and no more.” You should determine what amount of improvement would make the team feel proud of their efforts and want to share the accomplishment publicly. Challenge Goal Explain: 6. What is your achievable goal? NOTE: After considering starting point, seriousness, environment, and challenge, what is the achievable goal? Achievable Goal Achievable Goal:
Handout 5.4 Developing a Refined Improvement Goal—Answer Keys ETHICS ISSUE 1: Shared Decision Making with Patients—Advance Care Planning 1. Ethics 2. Ethical Standard Source(s) 3. Ethical Standard Description(s) with Exclusions 4. Best Ethics Practice “Should” 5. Metric 6. Current Ethics Practice “Is” 7. Reality Check 8. Achievable Goal 9. Refined Improvement Goal A recent review of care health records found that only a few patient requests for assistance with completing an advance were followed up on by clinic staff. VHA Handbook 1004.2 Care Planning and Management of Advance VHA Handbook indicates that additional about advance and/or assistance in completing the forms must be provided for all patients who request this Exclusion(s): Patients who change their minds about their requests for who withdraw from the Health Care System, or who now lack capacity. Primary care patients who request with completing an advance should receive it [unless patients change their minds about their requests for assistance, from the Health Care or who now lack Numerator: The number of primary care patients with assistance as measured by a note template completed by a social worker or someone trained ____________ Denominator: Total number of primary care patients who requested with completing an advance Method: Record review Sample size: 30 Time frame for data 1 week Current ethics practice was determined based on a of 30 primary care patient health records. Currently, 10% of primary care patients who have a request for assistance with completing an advance receive it. 1. Based on accreditation is required and monitored; starting point is 90%. 2. Although a serious issue, it is tolerable to miss providing as there are additional to address and assist with completing advance directives when a patient is to an inpatient setting. 3. Leadership support should be evident due to accreditation 4. Challenge goal could be any % above 90%. 90% of primary care patients who request with completing an advance will receive it. Increase the % of primary care patients who receive assistance with completing an advance from 10% to 90% by Q4, 20XX.
MODULE 2 MODULE 3 MODULE 4 MODULE 5 ETHICS ISSUE 2: Professionalism in Patient Care—Truth Telling 1. Ethics Issue 2. Ethical Standard Source(s) 3. Ethical Standard Description(s) with Exclusions 4. Best Ethics Practice “Should” 5. Metric 6. Current Ethics Practice “Is” 7. Reality Check 8. Achievable Goal 9. Refined Improvement Goal The quality manager for surgical found a number of instances in which events that caused harm that should have been to patients or personal were not VHA Handbook 1004.08 of Events to Patients There is an ethical obligation to to patients harmful adverse events that have been sustained in t he course of care, including cases where the harm may not be obvious, or where there is potential for harm to occur in the future. Exclusion(s): Patient is incapacitated, or otherwise unable to take part in the pro-cess, and there is no personal Adverse events that cause harm to patients on surgical services should be to the patient or representative [unless patient is deceased or otherwise unable to take part in the pro-cess, and there is no representative]. Numerator: Number of events that caused harm to patients that were disclosed to or personal representatives ____________ Denominator: Total number of adverse events that caused harm to patients on surgical services Method: Record review Sample size: 100% Time frame: Past 6 months Current practice was determined by identifying all adverse events that caused harm to patients on surgical services over the past 6 months through a review of incident reports. The health records of these patients were reviewed for a disclosure note. Currently, 65% of adverse events that cause harm to patients on services are being disclosed to or personal representatives. 1. Based on accreditation standard, is required and monitored; point is 90% 2. High level of seriousness where even one occurrence would be 3. High level of leadership support 4. Challenge goal would be 98%. 95% of adverse events that cause harm to patients on services will be disclosed to the patient or personal Increase the % of adverse events that cause harm to patients on surgical that are disclosed to the patient or representative from 65% to 95% by Q4, 20XX. MODULE 2 MODULE 3 MODULE 4 MODULE 5