Why Health Care Policy Matters

Summary

The speaker emphasizes the importance of improving care across four levels: direct interactions with patients, the micro systems where healthcare professionals operate, organizational leadership, and the broader policy environment. Each level plays a crucial role in enhancing patient care, and the speaker argues that clinicians must engage in shaping not only micro-level processes but also the macro policies that govern healthcare systems. This engagement includes influencing payment systems, training, and regulations to ensure the best care for patients, as the environment directly affects the delivery of care.

Takeaways

• 😀 The focus of care improvement is on four tiers that have been developed over the past twenty years.
• 🏥 The base of care improvement involves direct interactions with patients, whether through technology or physical exams and treatments.
• 👨‍⚕️ The micro system is the second tier, representing day-to-day interactions between healthcare professionals (like doctors, nurses, and pharmacists) and their processes to ensure safe, effective, and patient-centered care.
• 🛠 The micro system design is key to preventing issues like pressure ulcers and surgical mishaps, and ensuring true patient-centeredness.
• 🏢 The third tier involves organizational leadership, including C-suite executives and department heads, who set rules and manage budgets that influence care.
• 🌍 The macro system, or the world around healthcare organizations, influences care through policies, payment systems, and regulations.
• 📋 Healthcare professionals must understand that macro systems like policies and regulations are not 'above their pay grade,' and they should actively engage with these areas.
• 💡 Clinicians need to participate in shaping the broader context of care, including payment systems, training environments, and professional certification rules.
• ⚙️ Effective care improvement requires a 'chain of understanding' from the macro system to the micro system to the patient level.
• 🧠 The ultimate goal is for healthcare leadership to serve micro systems, enabling them to provide better care to patients and families.

Q & A

What are the four tiers of care improvement mentioned in the transcript?

The four tiers of care improvement are: 1) Interactions with people, focusing on helping patients live longer and better. 2) The micro system, which includes day-to-day interactions and processes like ensuring patient-centeredness and safety. 3) The organizational level, focusing on leadership and the management of C-suites, chiefs of medicine, and heads of nursing. 4) The policy level, which involves payment systems, regulations, and the training environment.

What is the 'micro system' as described in the transcript?

The micro system refers to the day-to-day interactions between healthcare professionals (e.g., doctors, nurses, pharmacists) and patients, as well as the processes that ensure care is delivered safely, effectively, and in a patient-centered manner.

Why is leadership important in improving care, according to the transcript?

Leadership is important because it helps guide and support the micro system and the organization as a whole. Leaders at the board level and in C-suites play a crucial role in creating the right environment for patient care, setting priorities, and ensuring resources are available.

How do macro systems influence healthcare organizations?

Macro systems, such as policies, payment systems, regulations, and training environments, set the rules and provide resources for healthcare organizations. These systems influence how organizations operate and ensure that they can support the micro systems that directly interact with patients.

Why is it important for clinicians to get involved in policy-making?

Clinicians need to get involved in policy-making because policies shape the environment in which care is provided, including payment, training, and regulations. Without clinician input, the policies may not be responsive to the needs of organizations or the patients they serve.

What is meant by 'creative molding of the arena of payment, regulation, and training'?

It refers to the idea that clinicians and leaders need to actively shape and influence the systems of payment, regulation, and training to ensure they support the type of care clinicians want to provide, rather than passively accepting existing structures.

What is the 'chain of duty' or 'chain of understanding' mentioned in the transcript?

The 'chain of duty' or 'chain of understanding' refers to the interconnectedness between macro systems, organizations, micro systems, and patient care. Each level is dependent on the other, and this chain ensures that care is delivered effectively and in alignment with broader policies and resources.

How does the transcript define the role of organizations in healthcare?

Organizations serve as the intermediary between the micro systems (e.g., healthcare teams) and the macro systems (e.g., policies and regulations). They provide leadership, manage resources, and create an environment that supports effective patient care.

What challenges are associated with the micro system in healthcare?

Challenges in the micro system include ensuring safety, patient-centeredness, effectiveness, and timeliness in everyday care. For example, preventing pressure ulcers, avoiding surgical mishaps, and maintaining a high level of patient-centered care.

Why is it necessary to integrate policy with clinical practice?

It is necessary to integrate policy with clinical practice because policies govern the resources, training, and rules that impact patient care. Without integration, healthcare organizations and clinicians may struggle to meet patient needs effectively.

Outlines

00:00

💡 Improving Care Through Four Tiers

The speaker discusses the framework for improving care, which is divided into four tiers. At the core is the interaction between healthcare professionals and patients, whether through online resources or physical exams. The focus is on helping patients live longer and better lives through direct encounters.

👩‍⚕️ Micro Systems: The Day-to-Day Interactions

This paragraph describes the micro systems of healthcare—daily interactions involving doctors, nurses, and other staff. It emphasizes patient safety, effectiveness, and a patient-centered approach. The micro system is the critical zone where healthcare processes are refined to avoid issues like pressure ulcers and surgical mishaps.

🏥 Organizational Influence on Micro Systems

The speaker explains that healthcare micro systems operate within larger organizations, such as hospitals. Leadership at this level—executive boards, chiefs of medicine, and nursing heads—plays a key role in supporting micro systems. The focus is on how organizational structures, physical environments, and budgets impact the effectiveness of patient care.

🌍 Policy and Macro Systems in Healthcare

Healthcare organizations don't function in isolation. They are heavily influenced by policies that govern funding, regulations, and training systems. The speaker argues that clinicians must engage in this broader policy-making environment to ensure that healthcare settings are responsive to both organizational and micro system needs.

🚀 Clinician Responsibility in Policy Engagement

This paragraph emphasizes the responsibility of clinicians to engage in policy and context setting. It highlights the importance of shaping payment structures, regulations, and training systems to support the care they aspire to deliver. Clinicians should be active participants in creating a healthcare environment that supports quality care.

Keywords

💡Improvement of care

The central theme of the video, which focuses on enhancing the quality of healthcare delivery. This involves continuous efforts to make healthcare more effective, efficient, and patient-centered. The speaker emphasizes that care improvement occurs at various levels, from direct patient interactions to larger policy frameworks.

💡Micro system

Refers to the day-to-day operations in a healthcare setting, such as the interactions between doctors, nurses, pharmacists, and other healthcare professionals. The speaker views the micro system as a 'sweet spot' where healthcare improvements, such as preventing pressure ulcers or surgical mishaps, can have a significant impact on patient outcomes.

💡Patient-centered care

A healthcare approach that focuses on the needs, preferences, and values of the patient. In the video, the speaker emphasizes the importance of designing processes and systems that prioritize the patient's experience and well-being, making sure the care is not just effective but also timely and respectful of individual patient needs.

💡Leadership

The role of organizational leaders, such as C-suites and board members, in improving healthcare delivery. The speaker highlights that leaders are responsible for creating environments where micro systems can operate effectively to serve patients and families, and must work to align organizational goals with broader policy frameworks.

💡Macro system

The larger organizational context that encompasses healthcare institutions. Macro systems include the architecture, budget, policies, and organizational structures that influence day-to-day healthcare delivery. The speaker explains that these systems must support the micro systems in providing effective patient care.

💡Policy

Refers to the external rules, regulations, and frameworks that influence healthcare systems. In the video, the speaker stresses that clinicians must engage with policy to ensure that it enables healthcare organizations to function effectively. Policy impacts training, payment systems, and professional certifications, all of which shape the care environment.

💡Payment system

A key external factor that affects how healthcare organizations operate. The speaker notes that the payment system influences the resources available to healthcare providers and the type of care they can deliver. Engaging with payment systems is crucial for ensuring that healthcare organizations are adequately supported.

💡Training system

Refers to the educational and certification processes that healthcare professionals undergo. In the context of the video, the speaker highlights the importance of having a training system that equips professionals with the skills and knowledge necessary to deliver high-quality care.

💡Patient and family

The ultimate focus of healthcare, according to the video. The speaker emphasizes that all efforts in healthcare, from micro systems to policy, should aim to improve the lives of patients and their families by delivering care that is compassionate, effective, and tailored to their specific needs.

💡Chain of duty

A concept discussed in the video that refers to the interconnected responsibilities within healthcare systems. The speaker describes this chain as crucial for ensuring that care is delivered effectively, from policy makers to leaders and down to the clinicians and support staff who interact directly with patients.

Highlights

Improvement of care is viewed in four tiers, emphasizing interactions with people to help them live longer and better.

The first tier focuses on the encounter, whether it's through a webpage, physical exam, or medicine, to ensure better care.

The micro system (second tier) involves day-to-day interactions with healthcare professionals such as doctors, nurses, and pharmacists to ensure safe, effective, patient-centered, and timely care.

Designing micro systems has been the focal point for 40 years, ensuring no pressure ulcers, no surgical mishaps, and true patient-centeredness.

The third tier focuses on organizations (macro systems) and their influence on the micro system, including roles like C-suite executives, heads of nursing, and the organizational context.

The physical design, architecture, rule bases, and budgets of organizations significantly impact the ability to improve patient care.

Leadership plays a vital role, with leaders serving the micro system so that it can serve the patient and family effectively.

The macro system does not exist in isolation; it is strongly influenced by external policies, which provide resources, payment systems, and training environments.

Policy and external regulations guide priorities and the certification processes for healthcare professionals.

Clinicians must engage with policy and regulation as it influences the environment in which care is delivered.

Payment systems, regulations, and training environments need to support the care clinicians aim to provide.

There needs to be a 'chain of understanding' that links policy, organizations, micro systems, and patient care.

Clinicians must play an active role in shaping the policy environment to ensure it supports the care they deliver.

Leadership training and involvement in policy discussions are essential for improving care systems.

The four-tier model emphasizes the interconnectedness of individual encounters, micro systems, organizational frameworks, and external policies.

Transcripts

I think of improvement of care always in

four tiers this is I've thought this way

for twenty years now that the base are

the interactions with people helping

this person live longer and better

whether it's through a webpage or a

physical exam and a medicine that's the

encounter

then there's the micro system there's

the that's the day-to-day interaction

that's the doctor and nurse or

pharmacist or receptionist that's

working with people and the processes

that allow you to do that safely

effectively in a patient-centered way

timely way

it's the micro system designs that's I

chose a sweet spot that's where we've

been for 40 years thinking what is that

interaction look like how do you have no

pressure ulcer how do you have no

surgical mishap how do you have true

patient centeredness that is doing the

micro system of course they're now in

organizations and so we deal all the

time with C Suites and chiefs of

medicine and heads of Nursing and

organizational context physical design

architecture rule bases budgets all of

that matters and so that's why we focus

on leadership and I chai leadership of

boards and C Suites and what do you do

to help improve and occur the leaders

should serve the micro system so it can

serve the patient and family but those

organizations macro systems they don't

they don't exist in a vacuum they are

strongly influenced by I guess we'll

have to call it policy that's the world

around them that's setting the rules

providing the resources and the and the

the way you get those are sources the

payment system they provide the training

system they provide the rules for

certifying the professionals what they

need to know and they provide the the

guidance for priorities you can't ignore

that you can't say that's above my pay

grade or I can't work on that you must

work on that because how can the

environment be responsive to the

organization's so they can be responsive

to the micro systems without interaction

without a chain of

custody chain of duty chain of

Understanding so I am arguing that we

clinicians we've just got to get

involved more than we ever have before

in that context context setting it has

to do with creative molding of the arena

of payment regulation training

environment for support of the care we

want to give

[Music]