Preventive Ethics

Preventive Ethics Beyond the Basics

Module 4 Describing Current Ethics Practice

Learning Objectives • Define what data are needed to describe current ethics practice. • Choose appropriate data collection methods to describe current ethics practice. • Develop an effective data collection plan to describe current ethics practice for a particular ethics issue.

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

Storyboard Progression Advance Directives Issue STUDY the Issue Gather and summarizeinformation about best ethics practice. Identify sources for applicable ethical standards Draft an operational definition of best ethics practice based on the ethical standard(s) and the specific ethics issue. Primary care patients who request assistance with completing an advance directive should receive it. Advance Directives Issue STUDY the Issue • Gather and summarize information about best ethics practice. • Identify sources for applicable ethical standards • Draft an operational definition of best ethics practice based on the ethical standard(s) and the specific ethics issue. • Primary care patients who request assistance with completing an advance directive should receive it.

Assessing Data Quality “Good Enough” Data • Must be enough to determine how often best ethics practice is actually occurring • Must have quality to convince others of level of current ethics practice

Before Collecting Data • Describe best ethics practice. • Decide what data you need to measure current ethics practice. • Identify who or what “counts.” • Measure must accurately describe current ethics practice.

Measuring Current Ethics Practice medium size mostly red firm all over Numerator: # Braeburn apples at fruit stand of medium size (150–250 g), mostly red, and firm all over • Denominator: total # of Braeburn apples at fruit stand (excluding all other types of apples)

Metrics:Advance Directives Issue The number of primary care patients provided with assistance # of primary care patients provided with assistance Total number of primary care patients who requested assistance with completing an advance directive # of primary care patients who requested assistance with completion of an advance directive

Best Ethics Practice Metric must match the description of best ethics practice! CAUTION

Metrics:Adverse Events Issue # of adverse events that caused harm to patients on surgical services that were disclosed to patients or personal representatives # of adverse events that caused harm to patients on surgical services

Group Activity InstructionsHandout 4.1 (20 min) Ethics Issues 3, 4, and 5 • Review Ethics Issues 3, 4, and 5 on handout. • Determine numerator and denominator, and consider exclusions. • Record answers.

Core Elements of Data Collection Plan • Method(s) • Sampling • Task definition and assignment • Time frame

Data Collection Methods • Health or other record • Observation • Interviews • Focus groups • Surveys

Data Collection Methods • Health or other record

Data Collection Methods • Observation

Data Collection Methods • Interviews • Telephone • Face-to-face • Focus groups

Data Collection Methods • Surveys • Mail • Internet

Data Collection Methods:Advance Directives Issue Which data collection method will likely provide the data necessary to describe current ethics practice? • Healthcare record reviews, if we are confident that the request and response are documented • Interviews―face-to-face or on the telephone―because they enable us to directly question patients about their experiences

Revisiting the Metrics:Advance Directives Issue # of primary care patients provided with assistance The number of primary care patients provided with assistance as measured by a note template completed by a social worker or someone equally trained # of primary care patients who requested assistance with completion of an advance directive Total number of primary care patients who requested assistance with completing an advance directive

Group Activity InstructionsHandout 4.4 (20 min) • Choose spokesperson. • In small groups, review ethics issue and best ethics practice. • Determine pros and cons of using each data collection method. • Choose top 2 data collection methods and prepare to share them with whole group.

Data Collection Bottom Line There are no perfect methods! The best data collection method is the one that provides data that match the practice we are interested in—and does so with the least amount of burden to the team.

Sampling • From which population are we sampling? • How much information do we need to describe current ethics practice?

Sampling Methodology The Joint Commission (TJC) sampling methodology • For a denominator of 30 or fewer, you would review all 30. • For 30–100, you would review 30. • For 101–500, you would review 50. • Above 500, you would review 70.

Sampling Plan Numerator: # Braeburn apples at fruit stand of medium size (150–250 g), mostly red, and firm all over • Denominator: total # of Braeburn apples at fruit stand (excluding all other types of apples) • Sampling plan: 10% (50 apples) or using TJC (70 apples). Either number would be an acceptable plan. • When to sample: depends on our purpose for collecting the data

Sampling Plan:Advance Directives Issue The number of primary care patients provided with assistance as measured by a note template completed by a social worker or someone equally trained # of primary care patients provided with assistance # of primary care patients who requested assistance with completion of an advance directive Total number of primary care patients who requested assistance with completing an advance directive 30 1 week

Task Definition and Assignment What tasks do we need for our record review collection? • Develop collection tool. • Collect the data from the healthcare record. • Summarize the findings. Who will do each of these tasks?

Time Frame for Tasks What questions do we need to ask regarding the time frame for each task in our data collection plan? • How long will each task take? • What is the target date for completion of each task?

Data Collection Plan Will our data collection plan provide the data needed for understanding current ethics practice? If the answer is no…

Current Ethics Practice:Advance Directives Issue 3 /30 = 10% The number of primary care patients provided with assistance as measured by a note template completed by a social worker or someone equally trained # of primary care patients provided with assistance Currently, 10% of primary care patients who have a documented request for assistance with completing an advance directive receive it. # of primary care patients who requested assistance with completion of an advance directive Total number of primary care patients who requested assistance with completing an advance directive 30 1 week

Group Activity InstructionsHandout 4.6 (10 min) • Choose (another) spokesperson. • Review information about ethical practice. • Fill in 5 steps for data collection plan on Handout 4.6. • Prepare to report to whole group.

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.

Takeaways Describing current ethics practice • Defining the metric • Measuring current ethics practice • Data collection methods • Determining sample sizes • Data collection plan

Questions?

Preventive Ethics