The Importance of Continual Learning in a Rapidly Changing Health Care Environment

The Importance of Continual Learning  in a Rapidly Changing Health Care Environment

 

Michael H Kanter, MD; Patrick T Courneya, MD

Perm J 2018;22:18-071 [Full Citation]

https://doi.org/10.7812/TPP/18-071
E-pub: 04/25/2018

Abstracts from the Kaiser Permanente 2018 National Quality Conference

Changes in health care are rapid with increasing participation from nontraditional companies in technology, pharmacy, and others.1 Most recently, Chase, Berkshire Hathaway, and Amazon announced a joint health care initiative and the formation of an independent company to focus on technology solutions for simplified, high quality, and affordable health care.2 The announcement sent immediate ripples throughout the health care industry and beyond even though it included no material plans or concrete details.

With the increase of available technology, the promise of new and nontraditional means to access care, and the general trend toward consumerism in health care,3 patients and purchasers are demanding more value—including higher-quality services, improved access, and lower costs. Moreover, as health care becomes more global through the advent of cloud computing and mass customization, there is growing demand for health equity and the mitigation of health disparities. Kaiser Permanente (KP) is already making great strides in this area and were recently recognized by the Center for Medicare and Medicaid Services as the first recipient of their new Health Equity Award.4 

New technology is rapidly being applied to health care, leading to great advancements in how we treat and prevent illness. Although this innovation has led to mostly favorable results, some significant problems have surfaced, such as alleged fraud,5 that require vigilance on the part of health care organizations. These lessons are not new. Looking back on examples like the harm arising from relaxed use of opioids and the dramatic change in prescribing that came as we learned about risks of postmenopausal estrogen use, we learn repeatedly the importance of sound evidence and continuous vigilance as new evidence comes to us through research. There is also increasing recognition that one of the most common causes of harm are diagnostic errors, which may affect more than 12 million patients per year.6 Improvement efforts are challenging because of difficulties in measuring the problem and the gap in time that often occurs between the initial error and its detection. However, KP has closed many of the systemic gaps that contribute to diagnostic errors through our SureNet programs.7,8 

There is also great demand to begin measuring outcomes that matter to patients and that go beyond process measures and a limited set of intermediate outcomes measures. Although the work is still in its infancy, KP is leading the way in this area with demonstrated reductions in cardiovascular morbidity and mortality.9

Because KP has created effective solutions to many national challenges that affect the health care industry at large, we feel it is important to publish the results of our learning and improvement efforts in hopes of supporting health care improvement outside of our system. For the 15th year, KP is convening its National Quality Conference and will again publish the abstracts of presentations at the meeting to help spread new quality initiatives throughout the nation. The abstracts cover each of the National Academy of Medicine’s 6 aims or dimensions of quality (safe, timely, efficient, effective, equitable, and person-centered),10 which also form the framework for KP’s National Clinical Quality Strategy. We recognize that there are many health care quality conferences of high value offered by organizations such as the Institute for Healthcare Improvement, the National Patient Safety Foundation, and others. However, we believe that large health care organizations can and should participate in creating quality forums where practices are not only shared but also published.11

How to Cite this Article

Kanter MH, Courneya PT. The importance of continual learning in a rapidly changing health care environment. Perm J 2018;22:18-071. DOI: https://doi.org/10.7812/TPP/18-071

References
1.    Hwang J, Christensen CM. Disruptive innovation in health care delivery: A framework for business-model innovation. Heath Aff (Millwood) 2008 Sep-Oct;27(5):1329-35. DOI: https://doi.org/10.1377/hlthaff.27.5.1329.
2.    Amazon, Berkshire Hathaway and JP Morgan Chase & Co. to partner on U.S. employee healthcare [Internet]. New York, NY: Business Wire; 2018 Jan 30 [cited 2018 Apr 2]. Available from: www.businesswire.com/news/home/20180130005676/en/Amazon-Berkshire-Hathaway-JPMorgan-Chase-partner-U.S.
3.    Babu R, Jayashree K. A survey on the role of IoT and cloud in health care. International Journal of Science, Engineering and Technology Research 2015 May;4(12):2217-19.
4.    Kaiser Permanente named first CMS health equity award recipient [Internet]. Oakland, CA: PR Newswire; 2018 Feb 14 [cited 2018 Apr 2]. Available from: www.prnewswire.com/news-releases/kaiser-permanente-named-first-cms-health-equity-award-recipient-300599018.html.
5.    O’Brien SA. Theranos founder Elizabeth Holmes charged with massive fraud. New York, NY: CNN Money; 2018 Mar 14 [cited 2018 Apr 2]. Available from: http://money.cnn.com/2018/03/14/technology/theranos-fraud-scandal/index.html.
6.    Singh H, Meyer AN, Thomas EJ. The frequency of diagnostic errors in outpatient care: Estimations from three large observational studies involving US adult populations. BMJ Qual Saf 2014 Sep;23(9):727-31. DOI: https://doi.org/10.1136/bmjqs-2013-002627.
7.    Sim JJ, Rutkowski MP, Selevan DC, et al. Kaiser Permanente Creatinine Safety Program: A mechanism to ensure widespread detection and care for chronic kidney disease. Am J Med 2015 Nov;128(11):1204-11.e1. DOI: https://doi.org/10.1016/j.amjmed.2015.05.037.
8.    Danforth KN, Smith AE, Loo RK, Jacobsen SJ, Mittman BS, Kanter MH. Electronic clinical surveillance to improve outpatient care: Diverse applications within an integrated delivery system. EGEMS (Wash DC) 2014 Jun 24;2(1):1056. DOI: https://doi.org/10.13063/2327-9214.1056.
9.    Solomon MD, Leong TK, Rana JS, Xu Y, Go AS. Community-based trends in acute myocardial infarction from 2008 to 2014. J Am Coll Cardiol 2016 Aug 9;68(6):666-8. DOI: https://doi.org/10.1016/j.jacc.2016.03.607.
10.    Institute of Medicine: Committee on Quality Health Care in America. Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academies Press; 2001 Mar 1.
11.    Kanter M, Courneya PT. Perspective on publishing quality improvement efforts. Perm J 2017;21:17-140. DOI: https://doi.org/10.7812/TPP/17-140.

Abstracts from the Kaiser Permanente 2018 National Quality Conference

The Importance of Continual Learning  in a Rapidly Changing Health Care Environment


Quality improvement (QI) activities are essential to create a learning health care system. Publishing QI activities has great value, encourages greater rigor, and helps facilitate greater willingness to share improvement opportunities.

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