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Malomatia.com Written by: André Snoxall (

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1 malomatia.com Written by: André Snoxall (email: asnoxall@malomatia.com)

2 Slide 1 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Consumers report a poor experience of the services offered by healthcare providers It is estimated that between 75 and 150,000 people die each year from the care they receive and through medical errors in the US healthcare system (iatrogenic events)75 and 150,000 In the US, medical errors are the fifth leading cause of death today In two major US teaching hospitals adverse events related to medicines, and that were preventable, resulted in increased costs of about $2.8 million per year Adverse events occur in between 2.9 and 3.7 percent of hospitalizations; –many of these errors and events could be avoided through improved processes and more effective use of technology

3 Slide 2 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. If we are to get the most from new technology, processes must often change The aspiration is transformation from: people helping people to: people, supported by technology, helping people supported by technology This shift is transformational: it fundamentally changes the way care is delivered

4 Slide 3 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Changing the way we provide care by making the best use of technology Objectives: 1.Keep patients well 2.Help patients to heal 3.Make encounters as pleasant as possible 4.Support healthcare workers 5.Reduce waste and improve performance

5 Slide 4 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. …but only as strong as the weakest link. Working together to serve the patient…

6 Slide 5 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Everyone involved with the healthcare “system” There is no “Opt-Out” button X

7 Slide 6 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. “By putting into action and meaningfully using an EHR system, providers will reap benefits beyond financial incentives…” US Government Meaningful Use initiative …a program set-up to measure, monitor and incentivize healthcare providers to achieve meaningful use following investment in electronic health records The program provides a best-practice framework against which we can drive targeted change facilitated by a CIS. Key performance targets should include: –The use of a CIS in a meaningful manner –The use of a CIS for electronic exchange of health information to improve quality of health care –The use of a CIS to measure and improve clinical quality

8 Slide 7 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. “All meaningful and lasting change starts first in your imagination and then works its way out. Imagination is more important than knowledge.” Albert Einstein Change can be imposed, however, imposing change from the outside will make it neither meaningful or lasting To be lasting, change must start from within… We are implementing technology and new-process mandates that will force change Our aim is to use this implementation as a catalyst for stimulating client stakeholders to drive change forward Training alone is not enough

9 Slide 8 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Change Time Training More adverse events Very unhappy patients Dissatisfied clinicians Heavily increased costs Significant investor dis- satisfaction Improved care Better outcomes (improved success rates) Increase in patient satisfaction More productive clinicians More effective expenditure Investor satisfaction Little change in adverse events or patient experience Dissatisfied clinicians Heavily increased costs Investor dis-satisfaction Technology “churn” Transformation

10 Slide 9 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Administration and clerical support staff Nurses Allied health-professionals Hospital consultants Non-consultant Hospital Doctors General practitioners Clinical support-providers Non-clinical support-providers Provider management team Investors

11 Slide 10 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Communication What’s in it for me? When will it happen? How will I be affected? Collaboration Observe and extrapolate; Anticipate; Share, and; Work together to mitigate risks Inclusion No discussion about me, without me; Involve groups of stakeholders in planning change.

12 Slide 11 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Provider Management Team Senior sponsorship (CEO, CFO, COO, CIO) Enterprise architecture documentation and sponsorship Focused workshops and discussions (finance, operations, HR, performance management) Program oversight

13 Slide 12 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. For Clinical Consultants Chief Medical Information Officer (CMIO) CIS Steering group Medical records committee Clinical governance committee Specialist advocates (surgeons, anesthetists, physicians, intensivists, ER consultants, radiologists, hematologists) Grand round presentations Flexible learning which has emphasis towards time based benefits and access to information (including one-to-one hands-on, out of hours sessions) White papers Published performance metrics Regular, targeted communication from colleagues

14 Slide 13 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. For Nurses, Junior Doctors & Allied health-professionals Medical records committee CIS Steering group Nurse manager involvement (wards, theatres [OR], emergency department, pediatrics, maternity) AHP management involvement Nursing informatics meetings Solution/scenario testing Published performance metrics Process documentation Appropriate targeted training (mix of 1:1, classroom, and on-line) Induction processes Prequalification of casual/temporary staff

15 Slide 14 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. For Administration and Clerical staff Focused workshops and discussions Manager involvement (outpatients, emergency department, theatres, wards, general practice, medical records) Procedure documentation: as-is / to-be Hands-on classroom based training with strong emphasis on context of CIS learning within individual job roles 1:1 go-live support and hand-holding Solution/scenario testing Performance-based pay Induction processes Prequalification of casual/temporary staff

16 Slide 15 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Finis QuestionsQuestions?

17 Slide 16 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. 190 Airbus A380 aircraft. Each carrying 525 passengers

18 Slide 17 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. US Pop. 2000 (Source: US Census Bureau)284 million Iatrogenic deaths as a percentage of pop. (US) 0.05% Pop. Qatar 2012 (Source: CIA Factfile)2 million iatrogenic mortality in 2012 if US statistics are extrapolated to Qatar: 1031 Key assumption: That Qatar healthcare is at least as good as US healthcare in terms of mortality rates in hospitals as a result of iatrogenisis Back

19 Slide 18 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. People who: book appointments; register patients; record details of activity and change of patient status; and communicate with patients and clinicians. These personnel probably have the biggest impact on “the patient journey”. If they get it wrong: appointments are missed; patients are inconvenienced; information is not recorded accurately; clinicians are misinformed; and time and resources are wasted. Back

20 Slide 19 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. People who: provide care and treatment to patients; collect and record clinical information that supports decision making; ensure that care is provided appropriately and when it is required; operate and maintain specialist equipment; and …did not chose this career so that they could operate computers! These professionals are characterized by: the immediacy of the impact if they don’t meet care obligations; their importance as observers and recorders of appropriate data; their role in “processes”; and their dependence on developing and following consistent processes to ensure quality. Back

21 Slide 20 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. People who: interpret information, perform diagnosis and recommend appropriate intervention within an area of expertise; perform clinical procedures; monitor activity and outcomes, measure efficacy, and define appropriate treatment protocols; and represent the pinnacle of their specialty within a health care system. Consultants are often characterized by: a desire for continuous improvement; the need for accurate, reliable, and appropriate information upon which to base immediate treatment decisions; an obligation to support the learning of junior doctors; and impatience with impediments to effective completion of their work. Back

22 Slide 21 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. People who: perform, search for and manage documentation; perform procedures, take bloods, request investigations, review results; ensure continuity of care through handovers; collect information from patients, diagnose problems; and provide advice or assistance. Non-consultant hospital doctors are generally: overworked; subject to the whims of the consultants who they work for; on a steep and continuous learning curve; and not in a good position to drive systemic change across their domain of experience and expertise. Back

23 Slide 22 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. Include enterprises such as: pharmacies; clinical laboratories; diagnostic imaging providers; IT service providers; and other non-interventional service providers who support the delivery of care. These enterprises are characterized by: their cost to the healthcare provider; their importance in enabling access to accurate, useful information upon which treatment decisions are based; and their dependence on specialist domain expertise to operate effectively and efficiently. Back

24 Slide 23 Copyright © 2012 malomatia (Q.S.C) All Rights Reserved. People who: define enterprise strategy and tactics to meet local challenges; measure and monitor enterprise performance; measure and monitor internal activity; Plan, manage and ensure access to resources; and ensure the quality and consistency of resources to support enterprise activities. These people are characterized by: their ability to understand clinical imperatives and convert these to meaningful plans and actions; The ability to work collaboratively to balance the needs of clinicians, patients and government; and their ability to make decisions inclusively and to communicate effectively with stakeholders. Back


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