The Culture of Healthcare Healthcare Processes and Decision Making Lecture e This material...

The Culture of Healthcare

Healthcare Processes and Decision Making

Lecture e

This material (Comp2_Unit4e was developed by Oregon Health & Science University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number

IU24OC000015.

Healthcare Processes and Decision MakingLearning Objectives

2

• Describe the elements of the 'classic paradigm' of the clinical process (lecture a).

• List the types of information used by clinicians when they care for patients (lecture a).

• Describe the steps required to manage information during the patient-clinician interaction (lecture a,b,c).

• List the different information structures or formats used to organize clinical information (lecture b).

• Explain what is meant by the 'hypothetico-deductive' reasoning process (lecture a,b).

• Explain the difference between observations, findings, syndromes, and diseases (lecture a,b,c).

• Describe techniques or approaches used by clinicians to reach a diagnosis (lecture a,b,c,d,e).

• List the major types of factors that clinicians consider when devising a management plan for a patient's condition, in addition to the diagnosis and recommended treatment (lecture e).

Health IT Workforce Curriculum Version 3.0/Spring 2012

The Culture of Healthcare Healthcare Processes and Decision Making

Lecture e

Keeping Track Of Care

“never ask a new patient a question without note-

book and pencil in hand...

Sir William Osler (1849 - 1919)

3Health IT Workforce Curriculum Version 3.0/Spring 2012


Lecture e

(Corner, 1905. PD-US)

Problem ListBuilding Relationship, Negotiating

Plans


• Diabetes– Polyuria, polydipsia, polyphagia– hyperglycemia

• HTN– high BP x 3– EKG shows left ventricular hypertrophy

• Hyperlipidemia– LDL 194– Triglycerides 250

• Body Mass Index 34


Lecture e

Who is the Audience?What is the message for each?

• Patient• Family, Friends, the

Public• Clinical staff – nurses,

lab, x-ray, therapists, pharmacists, dietician

• Yourself – now and later

• Colleagues

• Consultants• Insurance companies• Lawyers (plaintiff and

defendant)• Compliance officers,

regulators• Researchers, data

miners• Performance

measures5Health IT Workforce Curriculum

Version 3.0/Spring 2012


Lecture e

Communicating with Patient

• Patient education – what’s wrong

• Instructions – what to do

• Reassurance – what will happen

• Motivation, hope

• Acknowledgement, acceptance

• “I’ll be there for you”



Lecture e

Family, Friends, the Public

• What do they need to know?

• What will be best for the patient?

• What will be best for the family member?

• What can I legally tell?

• What can I ethically tell?



Lecture e

Clinical Staff

• Nurses

• Pharmacist

• Dietician

• Therapists: physical, occupational, respiratory, massage, acupuncture

• Lab

• X-ray



Lecture e

Oneself

• “Nothing clears up a case so much as stating it to another person” (Sherlock Holmes, 1893)

• Processing effect of recording case

• Effect of structure and order

• Impact of recording technology

• Prospective memory – notes to myself, a la “Memento”



Lecture e

Other CliniciansColleagues• Future responsibility for

patient• Format• Content• Detail• “Experts share knowledge

not only of their domain, but of the structure and goals of their discourse” (Evans, 1989)

Consultants• Ask a clear question – get

a much better answer• What to share – what to

leave out– Neurologist– Psychiatrist– Cardiologist– Radiologist



Lecture e

Insurance companies

• Documentation of the illness– ICD9

• Documentation of the procedure– CPT4

• Documentation of the process– Details to support the diagnosis and treatment

plan



Lecture e

How much detailIn what form?

• Lawyers

• Regulatory agencies

• Data mining

• Clinical and Outcomes research

• Quality and Performance improvement

• Patient Safety



Lecture e


Summary – Lecture eThis lecture examined:

• How clinicians gather patient data• How they analyze it and utilize distinct

techniques to reach a diagnosis and formulate a plan

• How clinicians communicate their plan with the patient and others who need information.



Lecture e


SummaryThis unit examined the process of diagnosis and determination of a care plan:•Role and nature of a clinician; classic and alternate paradigms•Information gathering, process, analysis•Diagnostic thinking and techniques•Models used to choose therapy and formulate a management plan•Communication of the management plan



Lecture e


References – Lecture e


References• Conan Doyle A. Silver Blaze. The Memoirs of Sherlock Holmes (1893)• Evans, D. A., & Gadd, C. S. (1989). Managing coherence and context in medical problem solving discourse. In D.

A. Evans & V. L. Patel (Eds.), Cognitive science in medicine: Biomedical modeling (p. 214). Cambridge, MA: MIT Press.

• Feldman M, Christensen J. Behavioral Medicine: A Guide for Clinical Practice, Third Edition. McGraw-Hill Medical; 3 edition (2007)

• Ley P. Communicating with patients: Improving communication, satisfaction and compliance. Psychology and medicine series. New York, NY, US: Croom Helm. (1988)

Images• Slide 3: Corner, T. C. (1905). http://commons.wikimedia.org/wiki/File:Sir_William_Osler.jpg. Retrieved November

2011, from Wikimedia Commons website: http://commons.wikimedia.org. Public domain image (PD-US).


Lecture e

http://commons.wikimedia.org/wiki/File:Sir_William_Osler.jpg

http://commons.wikimedia.org/

The Culture of Healthcare Healthcare Processes and Decision Making Lecture e This material...

Documents

Transcript of The Culture of Healthcare Healthcare Processes and Decision Making Lecture e This material...