Session 8

This section contains all of the suggested discussion questions for class meetings.

SESSION 8:

• (5’) Welcome Back

  • Students share any updates for the class; any comments lingering from the last session

• (60’) SME Speaks + Q/A

  • Dr. Mark Gwynne, Associate Professor and Medical Director for UNC Health Alliance, talks to the class about alternative payment models at UNC and the need for a culture shift to truly bring high value change to the healthcare system.

**(10') Break

• (20’) Discuss Module 10 - briefly

  • The course builds to this final module. Up to this point, we've learned to define value, to measure value through PROMS, to effectuate change through our bedside practices (i.e., high value prescribing), and how our systems can encourage high value medical practice. One of the ways to begin implementing such change is to determine through rigorous evaluation the practice areas (i.e., testing, diagnosing, communication practices) that yield little to no value, hypothesize solutions, act on those solutions and iterate. Again and again. Quality improvement processes help us through this process; and this module introduces various methodologies we can use.

  • Of the ways that we can carry out QI projects, was there a particular methodology that you liked the best?

    • If you’ve done a QI project in the past, describe your process.

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    • This module covered SMART aims – goal statements that asked the learner to state their goals so that they are Specific, Measurable, Achievable, Relevant, and Time-bound. Together, make a SMART goal that is specific to this group of learners (if you are working with early health professional students, you could choose a goal that has to do with their own lives rather than a clinical or health systems science example).

      • Then, based on the tools introduced in this module to plan and implement changes, discuss how this aim might be achieved.

        • The recommended tools are process charts, fishbone diagrams, pareto and special cause variation charts for understanding problems and monitoring results of implementations; using the COST framework (Culture, Oversight, Systems-change, Training) to identify barriers to and supports for implementation; laying out steps, roles, and responsibilities in a project charter; and measuring/monitoring results by identifying and gathering data and creating statistical process control charts etc.

      • This module discussed how the Lean approach to achieving better outcomes in health care focuses on reducing and eliminating waste from processes. In small groups, identify the areas in which learners see the most waste, and choose one. Define the processes that surround this issue. Choose one process and define how it should be changed based on which steps contribute to waste. Tailor this to the audience; if first-year medical students, you may want to remain as a large group and discuss areas of waste they perceive in health care through their academic or personal lives and discuss what processes likely contribute toward these.

        • Module 10 discussed utilizing process mapping to define process steps and stakeholders in order to identify where processes become inefficient, break down, or aren’t staffed appropriately. Mapping a process by its steps can help to illuminate where it needs to be improved.

• How Can You Lead from Where You Stand? (and Course Feedback)

  • (Note: At UNC, we ended up creating a separate class session that was devoted to final debrief)

  • Topics to discuss:

    • How as students (or clinicians, residents, etc.) we can bring change to the teams we work on?

      • Some ideas:

        • Communication strategies; introduce Choosing Wisely; Choosing Wisely badges; identify HVC champions

        • Create interest groups, journal clubs, events

        • Curricular changes

  • Course feedback

  • Don't forget to send out the post-survey!