Using the Healthcare Matrix with Interns and Medical Students as a Tool to Effect Change

Abstract

The Healthcare Matrix is a tool developed at Vanderbilt University Medical Center which assesses the care of patients using the Accreditation Council for Graduate Medical Education (ACGME) competencies and the Institute of Medicine (IOM) Aims for Improvement. House staff have been using this tool since 2004 as a means of learning the competencies in the daily care of patients. As the residents fill in the cells of the Matrix, the opportunities for improvement become evident. Anesthesia interns were introduced to the Matrix at bimonthly meetings to analyze a real case of complex and/or flawed patient management. Each resident completed his/her own Matrix and then the group selected one Matrix as their improvement project. This article will present one Matrix case, how quality improvement (QI) tools and methods were utilized and what resulting improvements were made. The analyzed case revealed numerous flaws with nonstandardized handoffs, incorrect and insufficient documentation, and unclear roles/responsibilities. An ideal process flowchart was developed highlighting improved handoffs and the need for a new admitting policy to the intensive care unit (ICU). The Healthcare Matrix is an effective tool for teaching the ACGME competencies in patient care. The resequencing of the competencies in the Matrix makes it easy to identify where improvements are needed. When taught the tools and methods of quality improvement, even interns can make a significant contribution to the improvement of patient care.

Review article: Closing the research gap at the interface of learning and clinical practice

“…With further analysis, articles were selected wherein interventions relevant to one or more of the three themes were studied, resulting in a final selection of 56 citations Twenty-one studies analyzed transitions in, during, and after residency education; 19 studies addressed the educational effects of duty hour limits, [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51] and 16 articles presented research on use of the competencies in teaching and assessing anesthesiology residents. [19][20][21][22][23][24][25][26][27][52][53][54][55][56][57][58] For the theme ''duty hours and the acquisition of competence'', the only articles included were those that assessed the effect of duty hour limits on measures of physician competence and those that studied changes in patient care experience in anesthesiology that could be attributed to the reduction in resident hours.…”

“…58 The focus is on approaches to teach and assess the non-technical competencies, including the development of validated tools. The aim of these new tools is to support faculty expertise in education and evaluation and not to supplant it.…”

“…101 There are recent examples that show the value of the competencies in anesthesiology. [53][54][55][56][57][58] Future research could build on this beginning to develop and validate explicit ''milestones'' of expected learning achievements modelled on the competencies or the CanMEDS roles. Such an effort has the potential to offer enhanced models for teaching and assessment that could bridge the three themes discussed in this article, lead to clearer aims for educational progress across the continuum, enhance the assessment of clinical competence under restricted hours while ensuring its acquisition, and allow society and the profession to articulate expectations for the capabilities and skills of physicians in practice.…”

Assessing Patient Care in Palliative Care Using the Healthcare Matrix

“…4 This became an important aspect of the quality improvement (QI) training for medical students and residents at Vanderbilt University Medical Center. 5,6 The healthcare matrix has since gained increasing popularity over time, and has been used to analyze various cases in psychiatry, anesthesiology, nephrology, neurology, pediatrics, obstetrics, and gynecology. [6][7][8] The healthcare matrix is particularly suited for dissecting the complex cases in palliative care because of the multitude of physical, psychosocial, logistical, professional, interdisciplinary, ethical, and legal concerns in patients with advanced diseases.…”

“…5,6 The healthcare matrix has since gained increasing popularity over time, and has been used to analyze various cases in psychiatry, anesthesiology, nephrology, neurology, pediatrics, obstetrics, and gynecology. [6][7][8] The healthcare matrix is particularly suited for dissecting the complex cases in palliative care because of the multitude of physical, psychosocial, logistical, professional, interdisciplinary, ethical, and legal concerns in patients with advanced diseases. In addition to quality improvement, this could be a useful tool for palliative care educational programs by helping fellows to dissect the complexity of palliative care.…”