thequalitypostGreetings from Cat, Saj, Ari and Jenica Welcome to the 119th edition of The Quality Post! In this issue, we share a recent article authored by Lev Malevanchik and colleagues regarding the care of patients with limited English proficiency in the hospital, highlight disparities in ACP documentation in Latinx patients and ask for your engagement in improving this inequity, offer a Provider Dashboard Tip of the Month, and share our True North Metric performance for FY21. inthisissue
Caring for Patients with LEP in the Hospital
Improving Equity in ACP Documentation
Provider Dashboard Tip of the Month
Submit to the Caring Wisely Project Contest
FY21 DHM True North Metric Performance Caring for Patients with Limited English Proficiency in the Hospital Improving communication with patients with limited English proficiency (LEP) using professional video-mediated interpretation (VMI) has been a Divisional True North metric for the past year and a half. Recently, Lev Malevanchik and colleagues published a manuscript in JGIM titled Stories from COVID-19 Reveal Hospitalized Patients with Limited English Proficiency Have Always Been Uniquely Prone to Social Isolation, which paints a striking picture of the impact of hospital visitor restrictions on this vulnerable patient population. In the article, the authors "recount patient stories illustrative of this isolation, generated by insufficient professional interpreter use, ad hoc interpretation, and scarcity of media in preferred languages. When confronted with the social isolation faced by all patients during COVID-19, we more clearly saw the healthcare disparities affecting patients with LEP." One such patient story is below. "I was connecting a 60-year-old, Spanish-speaking patient who suffered a stroke in the ICU. After muting the English-speaking sports commentators on his TV, I introduced myself and was met with a vacant stare. His nurse said, "He isn't verbal really." Once his family was on video, immediately the energy in the room changed. He brightened and was even occasionally responsive with one-word answers. The nurse remarked to the family how much he perked up when they got on video. The family asked her if she uses an interpreter to speak to him. The nurse replied honestly, "I do whenever we talk as a team, but not throughout the day." The wife asked, "Would you mind using the interpreter whenever you speak to him? He only understands some English and may have trouble understanding after the stroke." The authors conclude that patients with LEP deserve an equitable hospital experience where all clinical conversations are translated in their preferred language AND they have opportunities to connect socially throughout their stay. At UCSF, we are fortunate to have our tele-health inpatient video navigator program. If you have a patient with LEP or any patient who wishes to connect with loved ones using Zoom, you may place an order for the "Inpatient Video Navigator" in APeX. Inpatient video navigators are available to assist patients seven days a week from 8 am - 11 pm. Please also continue to use professional interpretation to communicate with your patients with LEP and help us achieve our True North Metric goal this year! Lead with Questions, Not Answers Chances are, most leaders are too focused on having all the answers -- and not focused enough on asking the right questions. It's time to recalibrate. Despite what you might think, expressing vulnerability and asking for help, clarification, or input can be a sign of strength and confidence, not weakness. The right questions are signals of trust -- and they can inspire people to trust you in return. For example, rather than telling your team about a new opportunity you've identified, ask them, "Do you see a game-changing opportunity that could create much more value than we've delivered in the past?" A big, simple question like this can inspire a burst of collaboration and creativity across the organization. And if you consistently demonstrate a question-first mindset, you'll help establish an overall culture of curiosity and learning that will keep your team innovating and responding to challenges effectively. So try it out this week: Ask your team a big-picture, open-ended question, and see if it doesn't lead to some new and exciting ideas. This tip is adapted from "Good Leadership Is About Asking Good Questions" by John Hagel III Improving Equity in Advanced Care Planning Documentation Improving advanced care planning (ACP) documentation in APeX has been a True North Metric for over a year now, and we have made great strides in improving this for patients >= 75 years or with advanced illness from a prior baseline of 19% in FY19 to > 50%. Even more important than the numbers are the innumerable stories we are hearing from you and other medical providers about how much easier it is to find a patient's goals of care discussions, code status, or POLST form by clicking on the ACP navigator. In spite of these improvements, an in-depth analysis led by a team including Michelle Mourad and Molly Kantor has shown that a persistent disparity in ACP documentation has arisen between Latinx patients and all other race categories with an absolute difference in ACP documentation of about 15% last year. A gap analysis is underway to help inform our targeted interventions, and if you have thoughts to share on why this disparity exists, please feel free to share with Michelle and Molly. In the meantime, UCSF Health has set a goal of achieving a 60% disparity reduction in inpatient ACP documentation for Latinx patients with advanced illness or >= 75 years of age, moving our Latinx population performance from 30% to 39% by June 30, 2021. The DHM Dashboard Dashboard Tip #4 You can select different time periods to track your performance (Fig 1). Use this feature to get your overall performance for the year, or to see your most recent performance prior to starting a stint to identify areas to work on. You can also select “Performance Over Time” in the “Select a Page” drop down menu to trend your performance on the various metrics over time (Fig. 2). Please email Logan (Logan.Pierce@ucsf.edu) or Saj (sajan.patel@ucsf.edu) with any questions, and check out the DHM Wiki Dashboard Page for more info! Submit to the Caring Wisely Project Contest |