Previously, I posted an article on outcomes in SMHC. The post stated the following: “An outcome is the result of an experiment or other situation involving uncertainty”. http://www.stats.gla.ac.uk/steps/glossary/probability.html.
We are uncertain about what works in HCSM, the degree to which outcomes are a function of other variables, and why. I presented the views of two experienced market researchers who are involved in measuring and evaluating outcomes. Outcomes in SMHC will aid us in identifying what works, what doesn’t, why, why not, and help identify ways to improve those outcomes. Applying outcomes measurement, needs assessment, goals, etc. to SM in healthcare or any other communication or learning strategy will improve patient care.
Needs assessment is the other bookend of a learning/education plan. Between a needs assessment and the outcome are the objectives, strategies, and tactics to achieve the goals.
I do not view SM in and of itself as a major driver of change in healthcare (HC). It is a tactic, a tool, and one element of any number of strategies (e.g. marketing, sales, awareness, listening, learning, etc.)
In order to effectively apply a tactic to strategy that achieves an objective we need to understand what is happening, why, and what are the needs. A well constructed simple needs assessment can identify gaps in your patient’s knowledge and establish objectives. Once this is done you’ll be able to create a strategy and apply the right tactic. (social media, direct mail, chats, texting,etc.)
What is a needs assessment? Wikipedia provides and excellent place to start: Needs assessment is a process for determining and addressing needs, or “gaps” between current conditions and desired conditions, often used for improvement in individuals, education/training, organizations, or communities. The need can be a desire to improve current performance or to correct a deficiency. The idea of needs assessment, as part of the planning process, has been used under different names for a long time. In the past 50 years, it has been an essential element of educational planning.
The following is from Dr. Bob Kizlik at http://www.adprima.com : “Just remember, any needs assessment is really nothing more than an organized, systematic way to gather information relative to some goal. It is the quality and attainability of the goal that sets the stage for everything.”
Let’s say you are a PCP with an average patient population. Approximately 8.3% of your 1,200 patients have active diabetes. You’ve reviewed your charts and find that there are about 25 patients whose HbA1c is averaging >9%. This is troubling because you are consistent in managing your diabetic population. Why are the majority of your patients’ in better control and this subset is not? To what can you attribute to this finding? What changes you can make that would lower the 9%?
Performing a simple needs assessment would offer valuable knowledge regarding this observation and can identify why this gap may exist and potential ways to close it.
By identifying the 9% you’ve begun a needs assessment–namely you’ve completed a chart audit. At this point your goal should be to determine if what you’re observing in your practice is similar or different from other practices. Are other practices seeing similar numbers to your? Are their numbers a function of staffing?
This can be done by:
Seeking expert opinion from a colleague with a practice similar to yours. Do they have similar numbers to yours? If not what are they doing differently? Is their outcomes a function of staff training, patient education, patient population, etc? Was this a goal they set out to achieve?
Once you’ve spoken with colleagues the next area that you may want to look at are national guidelines. A review of current guidelines may point to areas and actions that can aid in improving these patients HbA1c. It will also provide data regarding reasons patients are not adhering to treatment.
Finally, speaking with patients and staff will give you additional data. There are two ways to approach this. One approach are patients interviews or a survey. But before you begin you’ll need to identify what you are looking for.
These patients are not achieving the goals that the majority of your patients are achieving in regards to HbA1c. You have determined that you are doing the proper education and training and working within established guidelines. The majority of your patients are within the norms. What needs to be understood are standards this group has in regard to their knowledge, their skill in managing the disease day to day, their attitude toward the disease, their own healthcare, and their ability to accomplish tasks (diet, exercise, monitoring, etc.). Remember most people don’t know what they don’t know so direct questions may not help in understanding why that gap exists.
You may want to mail or email the questionnaire to all patients with diabetes in your practice for a comparative data set. Or you can just send it to those within the population you want to improve outcomes for. Another option is to offer to the survey to patients when they are in the office for a visit.
What I would recommend is that you state that the questionnaire is not directly related to them but for you to understand your patients with diabetes. It is a fact-finding exercise. This includes them as part of a resource not a target. They need to feel part of your practice, not an object of it. I won’t detail a questionnaire here. Rather I will present a way to capture the data and knowledge.
Capture some demographic data including resources patients use or trust in learning about diabetes. (All within HIPPA guidelines) But the key is to understand the knowledge and/or behavior these patients have in regard to diabetes. One tool are vignettes. Vignettes move the discussion from first person to third.
A vignette can be written similar to a case:
A 50-year-old neighbor comes to you and says he was just diagnosed with diabetes. He knows you have diabetes and respects your opinion. He is not sure he understands what he is suppose to about food and asks you what kinds of carbohydrates he should be eating?
What would you tell him?
In this way the patient is speaking to someone else and sharing their knowledge etc. in a non-judgmental environment. They become a resource and their answers are not about themselves. It is someone else. The fact is they will answer based on their knowledge and behavior. You’ve identified their knowledge without asking them what they know or don’t.
Without knowing where your patients reside in their understanding, knowledge, and behavior it is difficult to identify ways to close a healthcare gap in your practice that brings about beneficial health. It is far easier and more effective to create messages and tactics when you know why problems exist. If your needs assessment identified that a majority of this population was unsure of proper diet and they were active in some SM, holding monthly chats moderated by a nutritionist may change behavior. Needs assessment can make SM more efficient and productive.
I realize the time and effort to perform a needs assessment may be beyond the abilities of a busy practice. What I hope I’ve presented here is an opportunity to consider ways to improve outcomes at the practice level. Perhaps a number of practices or systems can join together to perform a larger needs assessment in order to share data that will change patient care.
In the end what I believe we need to do in HCSM is bring tools that are proven in learning to patients and practices. Until we examine educational needs of patients and measure outcomes throwing tactics like social media at patients in a random fashion will not yield the results we are seeking. We need to be as deliberate as P&G in our efforts to understand patient knowledge, learning needs, and behavior in healthcare at the individual practice level. Healthcare is local and personal.
“Better health is not a science problem, it’s an information problem.”
I welcome your thoughts and ideas regarding needs assessments and outcomes for patients at a practice level.