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Preventive Ethics

Preventive Ethics. Beyond the Basics. Module 5 Developing a Refined Improvement Goal. Learning Objectives. Identify required elements of a refined improvement goal. Apply required elements to write a refined improvement goal for a specific ethics issue. ISSUES Link . STUDY the Issue

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Preventive Ethics

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  1. Preventive Ethics Beyond the Basics

  2. Module 5Developing a RefinedImprovement Goal

  3. Learning Objectives • Identify required elements of a refined improvement goal. • Apply required elements to write a refined improvement goal for a specific ethics issue.

  4. ISSUES Link STUDY the Issue Diagram the process behind the relevant practice Gather specific data about best practices Gather specific data about current practices Refine the improvement goal to reflect the ethics quality gap

  5. Storyboard Progression Advance Directives Issue • STUDY the Issue • Define the metric and gather specific data about current ethics practice. • Numerator = number of times the practice actually happens. • Denominator = population to whom specific ethics practice applies. • 3 ÷ 30 = 10% of primary care patients who have a documented request for assistance with completing an advance directive receive it.

  6. CONGRATULATIONS!

  7. Review:Advance Directives Issue

  8. Formula for Refined Improvement Goal _________________________________________________ Direction of Change (increase or decrease by % or number) _______________________________________________________________________ Ethical Practice* From ________________________ (% or n) Current Ethics Practice By __________________________________________ Time Frame (quarter or more specific, if required) *EXCLUSIONS: To _______________________ (% or n) AchievableGoal

  9. Refine the Improvement Goal _________________________________________________ Direction of Change (increase or decrease by % or number) _______________________________________________________________________ Ethical Practice* From ________________________ (% or n) Current Ethics Practice By __________________________________________ Time Frame (quarter or more specific, if required) *EXCLUSIONS: Increase the % of Primary care patients who request assistance with completing an advance directive will receive it. 10% To _______________________ (% or n) AchievableGoal 4th quarter, 20XX Patients who change their minds about their request for assistance, who withdraw from the Health Care System, or who now lack decision-making capacity.

  10. Achievable Goal How much improvement over current ethics practice is expected, based on a 4-step reality check? Reality Check • Starting point • Seriousness • Environment • Challenge

  11. Reality Check 1: Starting Point • Performance requirements Example: Advance directives Joint Commission sets a performance requirement of 90% for the accreditation standard related to assisting patients who request assistance with completing an advance directive. • Benchmark or comparative data Example: Ethics consultations per annum Literature review could show how many ethics consultations are provided annually within similarly sized health care organizations that offer comparable services.

  12. Reality Check 2: Seriousness • Can one occurrence be tolerated? Example: Research on human subjects without their informed consent This practice should never happen without appropriate review and is comparable to a sentinel event in patient safety. • Can you publicly defend the achievable goal? Example: 65% of reportable adverse events that caused harm to patients are disclosed to patients or patients’ personal representatives. 35% of adverse events would be concealed from patients.

  13. Reality Check 3: Environment • Do local considerations impact the goal? • Constraints? • Supports? • Each institution is unique. • Examine apparent constraints to determine if they can be addressed without lowering the achievable goal.

  14. Reality Check 4: Challenge • Don’t go for the slam dunk. • What amount of improvement would make the team proud? • Avoid grandiosity. • It may take more than one cycle to reach the desired level of improvement.

  15. Refine the Improvement Goal _________________________________________________ Direction of Change (increase or decrease by % or number) _______________________________________________________________________ Ethical Practice* From ________________________ (% or n) Current Ethics Practice By __________________________________________ Time Frame (quarter or more specific, if required) *EXCLUSIONS: Increase the % of Primary care patients who request assistance with completing an advance directive will receive it. 10% 90% To _______________________ (% or n) AchievableGoal 4th quarter, 20XX Patients who change their minds about their request for assistance, who withdraw from the Health Care System, or who now lack decision-making capacity.

  16. Common Pitfall:Outcome vs. Strategy • Outcome is what is to be achieved. • Strategy is howwe plan to achieve the outcome.

  17. Common Pitfall Example (a) Update the policy on patients undergoing high-risk imaging procedures requiring signature informed consent by 4th quarter, 20XX. Increase the percentage of patients undergoing high-risk imaging procedures who have signature informed consent from [current ethics practice] to [achievable goal] by 4th quarter, 20XX.

  18. Common Pitfall Example (b) Educate physicians about the problem of DNR orders not being signed by the attending physician within 24 hours. Increase the percentage of DNR orders signed by the attending physician within 24 hours from [current ethics practice] to [achievable goal] by 4th quarter, 20XX.

  19. Group Activity InstructionsHandouts 5.1 and 5.3 (16 min) Ethics Issue 2 or 3 (1 issue per pair) • Using the information on Handout 5.1, fill in all parts of the formula on Handout 5.3 except for the achievable goal. • Use Handout 5.3 to guide you through the reality check. • Formulate your achievable goal. • Work together to construct a refined improvement goal. • Reconvene to share results with the whole group.

  20. Storyboard Progression Advance Directives Issue • STUDY the Issue • Refine the improvement goal to reflect the ethics quality gap (include a time frame, if possible). • Reality check • Starting point • Seriousness • Environment • Challenge • Achievable Goal: 90% • Increase the percentage of primary care patients who receive requested assistance with completing an advance directive from 10% to 90% by 4th quarter, 20XX. • Exclusions: Patients who change their minds about their request for assistance, who withdraw from the Health Care System, or who now lack decision-making capacity.

  21. Takeaways Developing a refined improvement goal • Formula for refined improvement goal • 4 steps of reality check achievable goal • Common pitfall—what to achieve, not how to achieve it

  22. Questions?

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