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Component 2: The Culture of Health Care

Component Guide

Health IT Workforce CurriculumVersion 4.0/Spring 2016

This material (Comp 2) 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. This material was updated in 2016 by Bellevue College under

Award Number 90WT0002.

This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit

http://creativecommons.org/licenses/by-nc-sa/4.0/

http://creativecommons.org/licenses/by-nc-sa/4.0/

Component Number: 2

Component Title: The Culture of Health Care

Component Description:For individuals not familiar with health care, this component addresses job expectations in health care settings. It discusses how care is organized within a practice setting, privacy laws, and professional and ethical issues encountered in the workplace.

Component Objectives:At the completion of this component, the student will be able to:

1. Discuss the concept of “culture” as it relates to health care professionals, the delivery of care in health care organizations, and the growth of health informatics.

2. Describe the major types of clinical personnel involved in health care, including their education and training, certification and licensure, and typical roles in health care.

3. Describe the major types of settings in which health care occurs including ambulatory care, acute and emergency care, hospital based and critical care, and community health and public health settings.

4. Describe the major processes of information gathering, analysis, and documentation used by clinicians to detect, understand, and prevent or treat diseases.

5. Give examples and explain the differences between common forms of care delivery including episodic one-on-one care, multidisciplinary care, interdisciplinary care, care of chronic conditions, population based care, disease management, long-term care, and end of life care.

6. Discuss the basic principles of evidence-based practice, including the application of the best evidence in clinical decision-making.

7. Describe common forms of quality measurement, performance improvement, and incentive payment schemes meant to influence care delivery.

8. Discuss the role of medical ethics and professional values in care delivery including such issues as ethical conflicts and health disparities.

9. Discuss the concepts underlying the application of privacy, confidentiality, and security to health care practice and information technology, being able to help individuals and organizations adhere to the HIPAA Privacy and Security Rules.

10.Discuss the sociotechnical aspects of health care and how they relate to health care quality, medical error, and patient safety.

Component Files:Each unit within the component includes the following files:

Health IT Workforce Curriculum The Culture of Health Care 2Version 4.0

Lectures (voiceover PowerPoint in .mp4 format); PowerPoint slides (Microsoft PowerPoint format), lecture transcripts (Microsoft Word format); and audio files (.mp3 format) for each lecture.

Application activities (discussion questions, assignments, or projects) with answer keys.

Self-assessment questions with answer keys based on identified learning objectives.


Component Units with Objectives and Topics

Unit 1: An Overview of the Culture of Health Care

Description:

This introductory unit discusses some of the underlying concepts of health, culture, and how health informatics applications can be used to study culture.

Objectives:

1. Distinguish between disease and illness.2. Discuss the relationship between health and the health care system.3. Define culture in the classic sense, as well as in the modern sense of the term, and

what it means for culture to be partial, plural, and relative.4. Explain the concept of cultural competence.5. Compare the concepts of culture, cultural safety, and safety culture in the context of

a health care organization.6. Describe the impact of multiple cultures in health care delivery interactions.7. Define acculturation and how it relates to working in health care settings.8. Discuss the role of culture in health informatics.

Lectures:

a. Lecture a (26:20)

1. What is meant by "the culture of health care"

b. Lecture b (18:24)

1. Learning more about the culture of health care

Suggested Readings:

Epner, D. E., & Baile, W. F. (2012). Patient-centered care: the key to cultural competence. Annals of Oncology, 23 (suppl 3), 33-42. Retrieved from http://annonc.oxfordjournals.org/content/23/suppl_3/33.full.pdf+html

Humes, K. R., Jones, N. L., & Ramirez, R. R. (2011). Overview of race and hispanic origin: 2010 census briefs. Retrieved from http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

Kakade, M. (2016). Decode a culture – task oriented vs. relationship oriented. Retrieved from http ://manasikakade.com/2015/04/decode-a-culture-task-oriented-vs- relationship-oriented/

National Quality Forum (NQF). (2009). A comprehensive framework and preferred practices for measuring and reporting cultural competency: A consensus report.


http://manasikakade.com/2015/04/decode-a-culture-task-oriented-vs-relationship-oriented/



http://www.census.gov/prod/cen2010/briefs/c2010br-02.pdf

http://annonc.oxfordjournals.org/content/23/suppl_3/33.full.pdf+html

Retrieved from http://www.qualityforum.org/Publications/2009/04/A_Comprehensive_Framework_and_Preferred_Practices_for_Measuring_and_Reporting_Cultural_Competency.aspx

Truong, M., Paradies, Y., & Priest, N. (2014). Interventions to improve cultural competency in healthcare: a systematic review of reviews. BMC Health Services Research. 14(1), 1. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946184/

Unit 2: Health Professionals – The People in Health Care

Description:

This unit discusses the health professionals who deliver health care and the training needed to work in these professions. The following professionals are described in this unit: physicians, nurses, advanced practice nurses, physician assistants, pharmacists, therapists, allied health professionals, paramedics, EMTs, dental professionals, mental health professionals, and social workers

Objectives:

1. Define terms used in health care and in health professionals’ education and training, including clinician, patient/consumer, disease, and syndrome.

2. Describe the education, training, certification, licensure, and roles of physicians, including those in primary care and other specialties.

3. Describe the education, training, certification, licensure, and roles of nurses, advanced practice nurses, licensed practical nurses, medical assistants, and medication aides.

4. Describe the education, training, certification, licensure, and roles of physician assistants, pharmacists, therapists, and allied health professionals.

5. Describe the education, training, certification, licensure, and roles of paramedics, emergency medical technicians, dental professionals, mental health professionals, and social workers.

Lectures:


1. Introduction and Physicians2. Non-clinical IT/Informatics Roles for Clinicians3. Effects of Changing Care Models on Clinicians


1. Nursing Professionals2. Non-clinical IT/Informatics Roles for Clinicians


http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3946184/

http://www.qualityforum.org/Publications/2009/04/A_Comprehensive_Framework_and_Preferred_Practices_for_Measuring_and_Reporting_Cultural_Competency.aspx



3. Effects of Changing Care Models on Clinicians

c. Lecture c (22:49)

1. Physician assistants, Pharmacists, Therapists, Technicians, Paramedics, Dental Professionals, Mental Health Professionals, Care Coordinators

2. Non-clinical IT/Informatics Roles for Clinicians3. Effects of Changing Care Models on Clinicians

Suggested Readings:

MedlinePlus. (n.d.). Health occupations. Retrieved from https://www.nlm.nih.gov/medlineplus/healthoccupations.html

National Association of Advisors for the Health Professions. (n.d.). Health professions links. Retrieved from http://www.naahp.org/PublicResources/HealthProfessionsLinks.aspx

U.S. News. (n.d.). Best health care jobs. Retrieved from http://money.usnews.com/careers/best-jobs/rankings/best-healthcare-jobs

Unit 3: Health Care Settings – The Places Where Care is Delivered

Description:

This unit describes health care delivery sites including outpatient care, hospitals, tertiary care centers, academic medical centers, the VA health care system, the military health system, the Indian health service, and non-traditional delivery sites such as school-based, community-based, and employer-based sites. It also specifically examines the structure, function and interrelationship between health care settings.

Objectives:

1. Differentiate the range of care delivery organizations, including primary care, specialty care, tertiary care, hospitals, clinics, the medical home, home health, hospice, and long-term care facilities.

2. Analyze the organization of health care delivery from the perspective of a continuum of care, including outpatient services, in-patient care, home care services, long-term care, and end-of-life care.

3. Evaluate the similarities and differences of community hospitals, teaching hospitals, and community health clinics.

4. Describe the various departments and services offered by an outpatient clinic, community hospital, academic medical center, and long-term care facility.

5. Explain the ways in which different outpatient and inpatient departments interact and how their services relate.

6. Describe ways data and information are created and used by people in different outpatient and inpatient departments.


http://money.usnews.com/careers/best-jobs/rankings/best-healthcare-jobs

http://www.naahp.org/PublicResources/HealthProfessionsLinks.aspx

https://www.nlm.nih.gov/medlineplus/healthoccupations.html

7. Describe ways in which medical and information technology have improved interdepartmental communication and, consequently, the patient experience.

Lectures:


1. Range of care2. Continuum of care


1. Departments and services2. Interrelationships between health care organizations3. Medical data use and impact

Unit 4: Health Care Processes and Decision Making

Description:

This unit describes the process used by a clinician to make a diagnosis and determine a care plan. This includes gathering information from the patient as well as other objective and subjective sources, managing and organizing the information, comparing the information to known states of disease, and developing a care plan for the patient.

Objectives:

1. Describe the elements of the “classic paradigm” of the clinical process.2. List the types of information used by clinicians when they care for patients.3. Describe the steps required to manage information during the patient-clinician

interaction.4. List the different information structures or formats used to organize clinical

information.5. Describe different paradigms and elements of clinical decision making.6. Explain the difference among observations, findings, syndromes, and diseases.7. Describe techniques or approaches used by clinicians to reach a diagnosis.8. 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.

9. Describe the role of EHRs and technology in the clinical decision-making process.

Lectures:


1. The clinical process - overview of the classic paradigm2. Gathering data and analyzing findings


3. Making a diagnosis4. The impact of EHRs and technology on clinical decision-making


1. Gathering data and analyzing findings2. Making a diagnosis3. The impact of EHRs and technology on clinical decision-making


1. Gathering data and analyzing findings2. Making a diagnosis3. The impact of EHRs and technology on clinical decision-making

d. Lecture d (16:07)

1. Making a diagnosis2. Choosing therapy3. The impact of EHRs and technology on clinical decision-making

e. Lecture e (13:50)

1. Making a diagnosis2. Choosing therapy3. Communicating the plan4. The impact of EHRs and technology on clinical decision-making

Unit 5: Evidence-Based Practice

Description:

This unit describes the application of evidence-based medicine (EBM). The discussion begins with the framing of clinical questions that can be answered by appropriate evidence. The discussion then demonstrates how to find and apply the best evidence for answering four major types of clinical questions: interventions, diagnosis, harm, and prognosis. The unit also introduces summarizing of evidence (systematic reviews) as well as clinical practice guidelines. The unit concludes with a discussion of the limitations of EBM.

Objectives:

1. Define the key tenets of evidence-based medicine (EBM) and its role in the culture of health care.

2. Construct answerable clinical questions and critically appraise evidence answering them.


3. Explain how EBM can be applied to intervention studies, including the phrasing of answerable questions, finding evidence to answer them, and applying them to given clinical situations.

4. Describe how EBM can be applied to key clinical questions of diagnosis, harm, and prognosis.

5. Discuss the benefits and limitations to summarizing evidence.6. Describe how EBM is used in clinical settings through clinical practice guidelines and

decision analysis.

Lectures:


1. Definition and application of EBM


1. Definition and application of EBM2. Phrasing the clinical question


1. Phrasing the clinical question 2. Interventions


1. Phrasing the clinical question 2. Harm and prognosis

e. Lecture e (13:19)

1. Phrasing the clinical question 2. Harm and prognosis

f. Lecture f (15:13)

1. Summarizing evidence 2. Putting evidence into practice

g. Lecture g (16:08)

1. Putting evidence into practice


Unit 6: Nursing Care Processes

Description:

This unit describes the processes used by a nurse in making clinical decisions and assessing patients. It also describes how nurses are trained, where they work and the procedures that they perform.

Objectives:

1. Describe what nurses do and how they are trained.2. Discuss the role of certified nursing assistants.3. Describe how nurses make clinical decisions and assess patients.4. Identify the settings where nurses work.5. Discuss the procedures that nurses perform.6. Identify nursing career opportunities, including those not involved with direct patient

care.

Lectures:


1. Nursing roles, responsibilities, and work settings


1. Nursing process including clinical judgment and patient assessment; legal and societal expectations; and roles in improving patient care


1. Nursing routines and procedures including performing invasive procedures, administering medication, documenting procedures, and using technology

Unit 7: Quality Measurement and Improvement

Description:

This unit describes the concepts of quality measurement and performance improvement. The unit begins by setting the context of known quality problems in health care and then describes how quality is measured and efforts to improve it. The unit also discusses the role of information technology, incentives for quality improvement, and quality measurement under meaningful use.

Objectives:

1. Define health care quality and the major types of quality measures: structural, process, and outcome measures.


2. Describe the current state of health care quality in the United States.3. Discuss quality measures used in various health care settings in the United States,

including those required for the HITECH (Health Information Technology for Economic and Clinical Health Act) meaningful-use program.

4. Describe the role of information technology in measuring and improving health care quality.

5. Describe the results of current health care quality efforts in the United States.

Lectures:


1. Definitions and framework for assessing quality2. What is known about health care quality


1. Current quality measures in use


1. Role of IT and informatics2. Results of current approaches to quality assessment

Unit 8: Ethics and Professionalism

Description:

This unit describes the traditions and values that guide physicians, nurses, and allied health professionals. It explores medical ethics, professionalism and legal duties and applies ethics and professionalism to specific topics, including health informatics.

Objectives:

1. Discuss foundational concepts in medical ethics and professionalism.2. Examine the relationships among ethical ideals, professionalism, and legal duties.3. Apply the general principles of ethics and professionalism to specific topics.4. Examine ethical issues in health informatics.

Lectures:


1. Ethics and professionalism


1. Ethical and legal standards



1. Contemporary topics in medical ethics


1. Ethical issues in health informatics

Unit 9: Privacy, Confidentiality, and Security

Description:

This unit defines privacy, confidentiality, and security of health information, including the HIPAA Privacy and Security Rules.

Objectives:

1. Define and discern the differences between privacy, confidentiality, and security.2. Discuss methods for using information technology to protect privacy and

confidentiality.3. Describe and apply privacy, confidentiality, and security under the tenets of HIPAA

Privacy and Security rules.4. Discuss the intersection of a patient’s right to privacy with the need to share and

exchange patient information.

Lectures:


1. Definitions of privacy, confidentiality, and security


1. Tools for protecting privacy and confidentiality


1. HIPAA Privacy Rule


1. HIPAA Security Rule

Unit 10: Sociotechnical Aspects: Clinicians and Technology

Description:

This unit looks at the challenges of adapting work processes to new technology, and the resulting impact on quality, efficiency, and safety. This unit also examines the phenomena of social and technical resistance to change, especially among clinicians.


Objectives: 1. Describe the concepts of medical error and patient safety.2. Discuss error as an individual problem and as a system problem.3. Compare and contrast the interaction and interdependence of social and technical

“resistance to change.”4. Discuss the challenges inherent with adapting work processes to new technology.5. Discuss the downside of adapting technology to work practices and why this is not

desirable.7. Discuss the impact of changing sociotechnical processes on quality, efficiency, and

safety.

Lectures: a. Lecture a (18:58)

1. Medical errors 2. Patient safety


1. Patient safety


1. Sociotechnical aspects of health care


Component AuthorsComponent Originally Developed by:

Assigned Institution:Oregon Health & Science University

Team Lead: Vishnu Mohan, MD, OHSU

Primary Contributing Authors:Paul Gorman, MD, OHSU

William Hersh, MD, OHSU

Tim Hickman, MD, University of Missouri

Vishnu Mohan, MD, OHSU

Lecture Narration:Voiceover Talent

Connie Bowman, http://www.conniebowman.com

Sound Engineer

Mike Collins, Glenwood Sound

http://www.glenwoodsound.com

Team Members:

Shelby Acteson, Med, Instructional Specialist, OHSU

Corkey Devlin, BFA, PMP, Project Manager, OHSU

Paul Gorman, MD, Curriculum Developer, OHSU

William Hersh, MD, Principal Investigator, OHSU

Tim Hickman, MD, Curriculum Developer, University of Missouri

Vishnu Mohan, MD, Curriculum Developer, OHSU

Nathan Skidmore, BA, Instructional Design Assistant, OHSU

Chris Weldon, BS, Web Specialist, OHSU


http://www.conniebowman.com/

http://www.conniebowman.com/

Component Updated by:

Assigned Institution:Bellevue College

Team Lead: Patricia Dombrowski, BC

Primary Contributing Authors:Pamela Charney, PhD, PR, CHTS-CP, BC

Pamela Matthews, RN, BSIE, MBA, FHIMSS, CPHIMS, Matthews & Associates

Vivian Todhunter, BC

Lecture Narration:Voiceover Talent and Sound Engineer

Rick Otte, Bellevue College

http://www.bellevuecollege.edu/its/teams/television-services/

Team Members:Pamela Charney, PhD, PR, CHTS-CP, Curriculum Developer, BC

Patricia Dombrowski, Principal Investigator, BC

Pamela Matthews, RN, BSIE, MBA, FHIMSS, CPHIMS, Curriculum Developer, Matthews & Associates

Margaret Murphy, MA, Instructional Design Lead, BC

Heather Neikirk, Project Manager, BC

Vivian Todhunter, Curriculum Developer, BC


http://www.bellevuecollege.edu/its/teams/television-services/

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Likewise, the above also applies to the Curriculum Development Centers (including Columbia University, Duke University, Johns Hopkins University, Oregon Health & Science University, University of Alabama at Birmingham, and their affiliated entities) and Workforce Training Programs (including Bellevue College, Columbia University, Johns Hopkins University, Normandale Community College, Oregon Health & Science University, University of Alabama at Birmingham, University of Texas Health Science Center at Houston, and their affiliated entities).

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