The Culture of Healthcare: Healthcare Processes and Decision Making Lecture e

The Culture of Healthcare
Healthcare Processes and

Decision Making
Lecture e
This material (Comp2_Unit4e was developed by Oregon Health & Science University, funded by the Department of Health and
Human Services, Office of the National Coordinator for Health Information Technology under Award Number
IU24OC000015.
Healthcare Processes and Decision Making
Learning Objectives
2
Describe the elements of the 'classic paradigm' of the clinical process
(lecture a).
List the types of information used by clinicians when they care for patients
(lecture a).
Describe the steps required to manage information during the patient-
clinician interaction (lecture a,b,c).
List the different information structures or formats used to organize clinical
information (lecture b).
Explain what is meant by the 'hypothetico-deductive' reasoning process
(lecture a,b).
Explain the difference between observations, findings, syndromes, and
diseases (lecture a,b,c).
Describe techniques or approaches used by clinicians to reach a diagnosis
(lecture a,b,c,d,e).
List the major types of factors that clinicians consider when devising a
management plan for a patient's condition, in addition to the diagnosis and
recommended treatment (lecture e).
Health IT Workforce Curriculum
Version 3.0/Spring 2012
Lecture e
Keeping Track Of Care
never ask a new
patient a question
without note-book and
pencil in hand...

Sir William Osler
(1849 - 1919)

3
Lecture e

(Corner, 1905. PD-US)
Problem List
Building Relationship, Negotiating
Plans
4
Diabetes
Polyuria, polydipsia, polyphagia
hyperglycemia
HTN
high BP x 3
EKG shows left ventricular hypertrophy
Hyperlipidemia
LDL 194
Triglycerides 250
Body Mass Index 34
Lecture e
Who is the Audience?
What is the message for each?
Patient
Family, Friends, the
Public
Clinical staff nurses,
lab, x-ray, therapists,
pharmacists, dietician
Yourself now and
later
Colleagues
Consultants
Insurance companies
Lawyers (plaintiff and
defendant)
Compliance officers,
regulators
Researchers, data
miners
Performance
measures
5
Lecture e

Communicating with Patient
Patient education whats wrong
Instructions what to do
Reassurance what will happen
Motivation, hope
Acknowledgement, acceptance
Ill be there for you
6
Lecture e
Family, Friends, the Public
What do they need to know?
What will be best for the patient?
What will be best for the family member?
What can I legally tell?
What can I ethically tell?
7
Lecture e
Clinical Staff
Nurses
Pharmacist
Dietician
Therapists: physical, occupational,
respiratory, massage, acupuncture
Lab
X-ray
8
Lecture e
Oneself
Nothing clears up a case so much as
stating it to another person (Sherlock
Holmes, 1893)
Processing effect of recording case
Effect of structure and order
Impact of recording technology
Prospective memory notes to myself, a
la Memento
9
Lecture e
Other Clinicians
Colleagues
Future responsibility for
patient
Format
Content
Detail
Experts share knowledge
not only of their domain,
but of the structure and
goals of their discourse
(Evans, 1989)

Consultants
Ask a clear question get
a much better answer
What to share what to
leave out
Neurologist
Psychiatrist
Cardiologist
Radiologist

10
Lecture e

Insurance companies
Documentation of the illness
ICD9
Documentation of the procedure
CPT4
Documentation of the process
Details to support the diagnosis and treatment
plan

11
Lecture e
How much detail
In what form?
Lawyers
Regulatory agencies
Data mining
Clinical and Outcomes research
Quality and Performance improvement
Patient Safety

12
Lecture e
Decision Making
Summary Lecture e
This lecture examined:
How clinicians gather patient data
How they analyze it and utilize distinct
techniques to reach a diagnosis and formulate
a plan
How clinicians communicate their plan with
the patient and others who need information.
13
Lecture e
Decision Making
Summary
This unit examined the process of diagnosis and
determination of a care plan:
Role and nature of a clinician; classic and
alternate paradigms
Information gathering, process, analysis
Diagnostic thinking and techniques
Models used to choose therapy and formulate a
management plan
Communication of the management plan

14
Lecture e
Decision Making
References Lecture e
15
References
Conan Doyle A. Silver Blaze. The Memoirs of Sherlock Holmes (1893)
Evans, D. A., & Gadd, C. S. (1989). Managing coherence and context in medical problem solving discourse. In D.
A. Evans & V. L. Patel (Eds.), Cognitive science in medicine: Biomedical modeling (p. 214). Cambridge, MA: MIT
Press.
Feldman M, Christensen J. Behavioral Medicine: A Guide for Clinical Practice, Third Edition. McGraw-Hill Medical;
3 edition (2007)
Ley P. Communicating with patients: Improving communication, satisfaction and compliance. Psychology and
medicine series. New York, NY, US: Croom Helm. (1988)

Images
Slide 3: Corner, T. C. (1905). http://commons.wikimedia.org/wiki/File:Sir_William_Osler.jpg. Retrieved November
2011, from Wikimedia Commons website: http://commons.wikimedia.org. Public domain image (PD-US).

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