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10% using code nerd caster 10. A link for membership is in the show notes Welcome to SLP Nerdcast. We're very excited for today's episode. We are here with Laura McWilliams,
who is going to teach us all about learning health systems. Welcome, Laura. Happy to be here. Thanks for having me. Thanks for joining us. You're here today to talk to us
about patient safety and quality for allied health professionals. But before we get started, can you please
tell us just a little bit about yourself? Yeah. So I am a medical speech pathologist. I, um, I talk about this a lot. I'm, I'm from Appalachia, um, and I'm
interested in how care can get into places of marginalized and, um, communities
that don't have as much support. Um, so I'll start and end there. Um, and I went to the university
of South Carolina, go Gamecocks. I did my fellowship in
Seattle at the Seattle VA. Um, I have special interests in
leadership, head and neck cancer. And startup culture, actually, when it
comes to speech pathology practice, and I, um, love everything safety and quality. That's awesome. Well, we could probably have a
million sidebar conversations being part of a startup, but that's not
what we're here to talk about. And I am going to read our learning
objectives and disclosures before we learn more about, um, Learning
health systems and why they're important and why we should care. So without further ado, let's get
through some of this boring stuff. Learning objective number one,
define a learning health system. Learning objective number
two, define PDCA cycles. Disclosures, Lara's financial disclosures. Lara receives a salary from
her primary employer HCA. consultant of Laura McWilliams, LLC. Laura's non financial disclosures. Laura is a member of ASHA SIG 13 and
is co leading a membership advisory group for patient safety and quality. Kate, that's me. I'm the owner and founder of Grand
Bois Therapy and Consulting, LLC, and co founder of SLP Nerdcast. My non financial disclosures,
I'm a member of ASHA SIG 12 and I serve on the AAC Advisory Group for
Massachusetts Advocates for Children. I'm also a member of the
Berkshire Association for Behavior Analysis and Therapy. Thank you. Amy's financial disclosures. That's me. I'm an employee of a public school
system and co founder of SLP Nerdcast. And my non financial disclosures
are that I am a member of ASHA, Special Interest Group 12, um, and I
participate in the AAC advisory group for Massachusetts Advocates for Children. All right. So we've made it through all of the
obligatory pieces and onto the good stuff. Um, Laura, why don't you start
us off by telling us a little bit about that first learning objective? Uh, what is a learning health system,
but I think also connected with that. What sort of, what got you interested? In your in your current role. Um, so learning health systems,
um, found me and I found it simply. Well, not simply we all we all
experienced coded in different ways and I think we all are still emerging from. That initial trauma where we
were in our lives, how we were to show up professionally and
personally and at work and at home. And 1 of the things about covet that
excited me out of all the things that were scary about it was, um. How rapid we were getting information
and how every day we would show up to work and there would be new
guidance or new information coming. And really those first few months
of my day to day is influenced by what researchers are doing
in the field today or yesterday. And that period of time where
we were shifting and adapting so quickly was just one that. It was scary to a lot, but
really felt amazing for me. Um, so I hung on to that feeling and I
realized I had special interests in how to get practice change and information
in the hands of clinicians quickly to, um, modify what we do on a day to day
basis and also to inform the future. So, uh, you know, as hard as
covet was, it, it definitely. Brought forward this idea of rapid
change and rapid implementation of literature and research. And, um, then also, uh, kind of compounded
with technology, which, which it just grew insurmountably more so during those 2
years, but also leading up to that point. So from there, I went on a journey
towards quality and safety because I started looking into cultures
of continuous quality improvement. That was really the only term that I
walked away with from, with my early COVID experiences that a culture
of continuous quality improvement. It is saying something to me about bigger
system change and, um, I was just in awe that our health systems responded
not perfectly, but in, in one, in some ways, you collaboratively to shift and
modify towards a really challenging time. So learning health systems, it's a. It's kind of, it's a, it's a, it's
a very big concept, but when you break it down, it is essentially
pairing knowledge generation with care connection for implementation of change. So we are using our knowledge, and we
are using that knowledge in practice, and then we're generating data to inform
how we're going to care about change. For our patients and do the
things we do moving forward. So there's other definitions out
there, but that's how I see it. An info technical human connected,
uh, quality improvement, continuous improvement process. I have a question. And I don't, I hope that this isn't
considered like a bad, I know there's no such thing as bad questions, but
as you were talking, I was thinking about, you know, how you've described
COVID and the silver lining of being able to get information at our
fingertips, straight, hot off the presses, right out of the researchers,
right off the researchers desks. And I'm wondering if you could tell us a
little bit about why that was a big deal. So what is the regular everyday
culture of Of how that process happens. I know we've talked a lot about this on
the podcast previously, and I can put some additional references in the show
notes, but what was the regular everyday context that made this feel like a shift? Why was, why was this a new thing? Yeah, so I think that the, uh, a number
we all hear is it takes 17 years to get something from research to
practice and that's a huge gap. But really, when you break it down
and you look at the actual system, um, adopting and understanding what happens
when it's in practice, it actually takes about 35 years for it to be. Um, with, with, we have a
new, new research article that informs how we should be caring
for congestive heart failure. It takes 17 years to get that in. I have a one year old, so that
would be like when they graduate. Right. So I'm, I'm, I'm not okay with that
when it comes to my day to day practice. So what COVID did is it brought out the
potential that if we have new information. We started to develop information
sharing highways to implement it tomorrow and then modify it as we go. So it became a stark contrast
compared to new literature and public health safety information that
could be adopted within 48 hours. And I think there's something
really beautiful to that change. It showed me the possibility. I also think, you know, there's
a lot of context and, um, culture surrounding why that happened, right? I mean, this was a state of emergency. Everyone was staying home. It was, you know, it was a matter of,
of fear and, and safety, I think is like the, is the big, uh, You know, word that
you've used several times and I'm sure that created a lot of motivation to get
that information out of the researchers hands right into the clinicians hands
within 48 hours instead of 35 years. Um, and I'm wondering if this. Phenomenon has opened up new vehicles
for things that are not safety related. So we're speech pathologists. Let's take articulation. There are, there aren't our
emergencies that I'm aware of, um, that maybe there are out there. I don't want to belittle anyone's
articulation emergency, but how, how are these vehicles of, um,
information dissemination been translated into work that is not safe? a safety or emergency related issue? Yeah. So I think in my, also in my learning
about learning health, health systems, um, it could be something big or small,
um, that, that just needs attention. And when I look at speech pathology
practice, you mentioned articulation therapy, um, or articulation, uh, research
whenever we are in clinical practice. We need to realize we, as the end user
of the therapy strategies, can be data capturers when we are, uh, using different
strategies for articulation, forgive me. I don't know many because I'm an
adult speech therapist, but let's just say that there's 1 that is commonly
known, and you're using it with this patient and you're not documenting or
capturing the data of how this patient is progressing and then feeding it
back to a place where data is captured. housed and kept to then
see, is this informing? If this is working, you, you are
not connected to a larger system. So let's think about like L VADs, right? We have, um, LVAD devices where you have,
uh, left ventricular heart failure and you have an external device, uh, supporting
your cardio, your your heart rate. Your heart work, your heart flow. Sorry. Um, no, it's fine. I was going to ask you
what an LVAD device was. So I'm glad that you're explaining it. So those devices are built to capture
data to send to a central source to inform what the patient needs to modify the
device so they can then live healthier, perform better, not be as tired. Um, so those devices are built to From
a technological standpoint to inform a doctor this is or isn't working,
you need to change these settings. And then the doctor modulates the
device to then help the patient improve. So then imagine if you had 10
people all with LVAD devices, very similar health histories. That is a pool of information
that is getting captured to then potentially inform the next
generation of LVAD technology. That can improve the life
of people who need it. So, go back to that articulation example,
if you are using a specific treatment, uh, uh, approach, and you're capturing
data for you for the patient, but you're not, you're not capturing it in a manner
that's informing researchers or informing leaders, or you don't even need to be a
researcher, let's say it's your group of pediatric speech therapists that just want
to Want to do better with articulation and understand if it's working. Um, if you, if you have a uniform place
to capture it, review it, say, hey, this therapy really isn't working that
well, or it is working, but 1 therapist. Her data looks a little bit different. It then starts to show you patterns
to push into continuous improvement with this tool that you have. So, um, you know, I think. When you, when you pull back
one of the most exciting things. In a learning health system is you
can have a learning health community, a learning community anywhere. And that is something that I continue
to invite speech therapists to think of. We don't need to go to the
research meccas to change practice. You actually can be in your practice
in the community now, forming your own learning health system to
continuously improve what you're doing. And, um, since I've taken that approach. I actually know that my conversation
with researchers who are studying very aspect, very various aspects of it have
strengthened and actually it's influenced. Maybe their approach for more places
where more funding comes for practice change and literature to inform our care. So, and I think that, you know, that feedback
loop of our, um, data informed practice, which by the way, is part of our
evidence based practice triangle, right? So we should all be doing this as
part of our regular everyday jobs. We should be using our internal evidence
or the data that we collect to inform our treatment and in combination with what
we know from external literature and. patient and center values,
clinical judgment, etc, etc. So, but that feedback loop of the data
that we collect in our sessions, going back to the researchers to help inform
research questions, to help provide additional analysis is a critical piece
of improving so many things, right? Yes. I'm, I'm wondering if you could talk
to us a little bit about, so you work in a hospital, Amy and I are pediatric
therapists, Amy works in a school, I'm in private practice, different workplace
settings have different infrastructures and what you're talking about in this
learning health system is a system, right? It's an infrastructure. What can you tell us about, you know, for
those people listening who are thinking, oh, this is kind of, this is kind of cool. This makes a lot of sense. Sure. What infrastructure needs to exist
for a learning health system to be adopted or created or, or implemented? Yeah. So, um, this is why I love patient
safety and I love learning health systems because it talks a lot about culture. And you have to start putting words
to the culture that you want, right? You, um, inpatient safety practice, I
know we're not there yet, but I love it. You have to have a culture of, I care
about what happens to my patient. And I care that if I notice something
is wrong, I feel safe in reporting it. That's called, that's a just culture. That's a big to do on the, um,
just patient safety and quality, uh, goals for our country. So it starts with culture. So also in this culture for
a learning health system, you have to have people committed. To the problem you're noticing, or
the challenge you're noticing, or the, um, something that is not in line or
aligned with a good outcome to say, we all sit in different roles, but we're
committed to improving this thing. I'm going to talk about
Drake teams, because that's. My wheelhouse, and I think that's a really
good example of a learning community because you need strong leadership. What do you need? You need strong leadership committed
to a common goal, not the same professionals, but committed to
improving this thing related to your, your role or your involvement. You have to have a good understanding
of what are your data capturing tools. How are you using your EMR? How are you not using your EMR? How are you not using your EMR? Um, some other tools where you could
develop a platform to capture data. So we talk about EMR, but
there's also a good opportunity to use an Excel spreadsheet. It's on a shared drive to capture
data related to this thing. So I don't want to complicate that. And I think that when people hear
data, they think, Oh, this big nerd sitting in a corner looking at a
spreadsheet, but really there's just easy ways to get people capturing
data about what we're doing in a day. And we're kind of already doing it. Right. Um, And then back to that culture,
the culture that's committed to, we're never going to find perfection here,
but we're going to keep getting better at this thing with every cycle that our
team or our subgroups in this learning community goes through to improve. Well, and just to, like, jump in with
a completely different system of public school, I actually think a lot of,
if you zoom back and think about it super broadly as just creating a system
of shared goals, there are a lot of mechanisms in place in a lot of schools. where people could leverage that. So we have a lot of like professional
learning communities or things like that. We have student data that we're
already collecting as part of our, you know, literacy programming. So there are places as I'm hearing you
speak, just as somebody who's in a really different work environment, I'm getting
excited about what you're talking about, because we do so much of the individual,
you know, how is this working for my client, but the idea that We, especially
as speech pathologists, who I feel like in schools don't have this opportunity
that often, like we could feed that information back into a bigger system. It's just, it's super exciting. It's really exciting. And you captured something that is kind
of the precipice of it is technology changes so fast that if you find a tool
that's capturing information in 1 way, unrelated to what you're doing, copy that. That data capturing tool and. Use it for your purpose. So I started talking about covid. I have young kids. I'm very interested in the R. S. V. like increases throughout the year. We have such amazing
infrastructure data capturing and communication related to covid. What about R. S. V. Why can't we take those same, um,
concepts of how we track and test and get information related to that? COVID and use it with other common colds
that really strain our health care system. So I'm out of the speech realm and more
in the public health realm, but you've hit on a very important topic that
you don't need to recreate the wheel. There's already really good systems
out there that can be adopted to the purposes of speech therapy or your
educational pediatric adult workplace within the multidisciplinary realm. I think something that you've hit on
that's really important and you, you mentioned it earlier is Looking at
your workplace culture and as you're thinking about all these things, what
infrastructure do we already have? This is kind of cool. I might want to think about
talking to my boss about this or thinking about leveraging some
systems that are already in place. I think it's critical to also think
about Your workplace culture and that underlying those underlying
values, values, those implied shared ideas and values about caring. I know it sounds so simple, but if you
have a shared understanding with the rest of your coworkers, with your bosses,
with your company's mission statement, with your state regulations, right? Your shared understanding about caring
about your students, caring about your patients, caring about your clients, that
is the foundation on which to say, okay, if we care, if we collectively say that
we care, then we should be leveraging what we have to improve what we're doing. Right. I mean, there's like a really, I know
that's so obvious, but I think it's a really critically important connection
because if you do want to take any action steps, you have to have that shared
understanding and it's not budget or. I don't have, we're all working
with limited time and money. That's like half the problem
in our post COVID world. But I think that having that understanding
of we are doing this for a reason. And it's because we are
here for patient safety. We're here for student outcomes. We're here for improvement. That is, that is the reason. That's the reason. And that's what we have to leverage. Right. Tiny soapbox. Well, and no, I love that. So I love that. And you also touched on something that
I think in this learning helped me be okay with not necessarily, uh, always
asking for full permission because I am the person that's connected
to the outcome of my patient and better understanding, understanding
my leadership and my manager. Is here to support my, my resources,
my needs, but they aren't necessarily consistently interested in the same things
that I might be connected with somebody outside of my direct leadership change. So that is why the foundation
of the learning community. The multistakeholder multidisciplinary
work is so important because I think we've all been in jobs where finally you get
some of that respect and autonomy to just go and start selling solving problems. That's the beauty you need to leverage
that and that's the perfect time. To create, um, a learning health
system to improve something. It might be big. It might be little, um, or at
least to implement practice change. Um, I also figured this, um, you know,
so Charles Friedman, he's in the, the resources, he's a, um, an amazing
researcher at University of Michigan. And he's kind of like, 1 of the
grandfathers of learning health systems. Um, and he. He says it best, and I'd like to read
a quote just that that helps bring innovation to the, to the foreground. So he describes it as a system in which
science informatics incentives and culture are aligned for continuous improvement
and innovation with best practices. Seemly seamlessly embedded
in the care process. Patients and families as active
participants in all elements, and new knowledge is captured as an integral
byproduct of the care experience. And when I read that, I get chills
because that's, that almost encompasses everything we, as clinicians, providers,
community members want for us, for our clients, and for our communities. So, um, yeah, so I'd like to
give an example or any other questions before I go into that. Now I was going to, I was going to
ask you to give us your, kind of walk us through your trach example, which
Kate and I will know very little about actual, about the actual clinical
skills related to that, but we will, we will look at it big picture. Yeah. So, um, maybe so, so, okay. So you have a multidisciplinary trach. team. And that is the perfect example
of a learning health community. If you are a speech therapist, a
critical care doctor, um, a care manager, a nurse, a respiratory
therapist, um, or an administrator. So there's there's six groups that
are in your learning health community. You're all committed or interested in
how can we manage and support traits better in our hospital to help them. receive better care. When you look at a health care
problem, surgical airways are very unsafe in the community. So the goal is to rehab them,
decannulate them, get the trick out of their neck, reduce the line and tube,
improve their communication, improve their swallowing quality of life. Um, and it also makes their risks in
the community less because they have a lower bounce back to the hospital rate. So everybody's interested,
but we all are very different. So what you do is you form the learning
community, you align with capturing information on what is your current state. What do we know about trachs? How informed are we? Do we have updated materials? Do we have good documentation to
capture the data we want to capture? So, is a trach present? Are we decannulating them? How quickly is it happening? What are the barriers to discharge? So you have to set the scene to make
sure you know your current state. You assemble your data. You analyze what it's telling you,
which it kind of shows you the gaps in all of these different roles. So, I'm talking about this as if we're all
sitting down at a table and reviewing it. We're not. That respiratory therapist is
looking at their own EMR and saying, these are my gaps. That speech therapist is
looking at their own EMR. These are my gaps. Administrators. Oh, wow. Length of stay. These are some big things
that are important to me. So, when you look at the. Cycle of, um, planning, doing,
assessing, um, our PDSA cycle, I think about this back, backwards. Um, each group is doing their own PDSA
cycles to take a look at what is in place. To then try something different to
improve the care they're providing all in their own, uh, cycles of improvement
and then coming back together at a touch point to say, are we seeing
improvement collectively as a group? What is this data? That we're putting in, changing
us, informing us with the changes that we are making. So, at the end of the day, what
it really is is we kicked off a quarterly meeting where we sit down
and say, we are the airway task force. This is going to be. This is what we need to be more informed. These are some changes we need in EMR. These are some specific practice
approaches we need to do. So for us, it was meeting more
frequently, engaging care management, working with stakeholders for
discharge planning, and capturing, um, length of stay a little bit better. And so after we implemented those
four changes across our learning community, what we saw is our length
of stay reduced by about six days. And that's now informing us something,
something worked, something changed. And after we go through a learning cycle
together as a group, which could be a year, six months, however long, that
gives you an opportunity to sit down and say, we've made these great improvements. What next? And you continue the cycle of
continuous quality improvement. So I'm going circles like this,
but really what it is is it's a tornado because you have the cycles
more horizontal and they're all the groups are cycling together to
improve what is in front of them. I want to take a minute and just talk
about, I think the problem with project management and big scale system change
is we have a really bad practice of waiting for the meeting to do the thing. You know, you wait for that meeting to
tell everybody what you've done and then you leave the meeting and say, well, I
don't know what I need to do in between. So, the difference in the
learning health system is. You're forming the learning community
and empowering with the autonomy to improve what is in front of
you with the role that you're in. But the biggest thing is you have to
have that common goal and you have to be committed and you have to have
strong leadership to allow and support this, this, um, science practice
change, this PDSA cycle to, to unfold. So to say this back to you, the PDA
cycle stands for plan, do, check. Act, right? And this is a, it's a, I
mean, we keep saying circle. It's a cycle for everybody listening. It doesn't have a visual can't
see us moving our hands around. This is a, this is a circular experience
where presumably after you act that last component, you've circled back to
planning again with the new information that you've learned and a PDA cycle. This is a, I'm not a hundred
percent sure I have this correct. The PDA cycle is a. Unit of or a component of
a learning health system. Is that correct? Yes. So the speech therapist, our plan do
study or check and then act in that learning health cycle is speech therapist. in the trick team are assessing. How are we aware of tricks? What are we doing with tricks? What's our foundational
knowledge of tricks do we need? And then you move into the
do what we've identified. We need updated competency. We need updated supplies. We need in services. Um, and we need a better approach to
how we're managing patients in the day. And then You do that, you study, or check,
depending on who you are, it's check or study, um, if it, what the outcome was. Did it work? Did it improve anything? Did we learn something? So you're using that analytical skills
that all speech therapists have, but more in a programmatic mindset. And then you modify. So you've learned what works, you
embed it into your team culture, or you identify, we still haven't hit the
mark on how we approach patients in the day or how we plan our day, we're
going to modify this, and then you've kicked off another learning cycle. So, you know, I, I follow Simon
Sinek, he talks about the infinite game, um, you know, learning
and growing is an infinite game. You're never really there. And I think sometimes clinicians get
bogged down by that concept of like, Oh, we're never going to be there. We're never going to, but
that's, that is healthcare. That is quality improvement. I never want to be bored. I never want to run out of
things to continue to improve. Because if I do, I'm likely not
paying attention to how the info technical highway of health care is
changing and I'm not a part of it. So, that's also the other side of this
is getting your groups more engaged with learning communities and the learning
community mindset will naturally start. Embedding speech pathology practice into
our systems better and that is 1 thing. I think it's a whole
other podcast that I get. I get concerned about is. speech therapists and allied health not
being fully implemented into Big data capturing vessels, um, because insurance
companies, payers and, um, risk analyzers, big data, people who are looking at
what is being put into these systems are modifying our approach to care based off
of the information that they're getting. So, now is the time everybody is
a speech therapist to ask what is my data footprint in my workplace? And is it informing what
is good for my patient? And that is the essence of
a learning health system and learning health community. I love all of us is making me very
excited and intimidated and overwhelmed, but excited all at the same time. It's a lot of feelings. But as, as you're talking and Amy, I'm
sure you can talk about this more, but. It's making me think
about systems in a school. You know, you've used this wonderful
example of trach care, um, and hospital systems, which I, I think the, the
two settings are just so different, but when you talk about using data
to inform the system and using data to inform policy or procedure at the
administrative level, Amy, it's making me think about the role of the speech
pathologist in a school for all of these things that are shared across like
Like literacy, for example, that you're sharing with so many disciplines and
how our I love the term data footprint. I want to highlight that for a
second to how our data footprint can help inform all of the other
professionals within a system. That have that shared scope with us. I don't know if, if you agree being the
school person on the, on the call here, I mean, it did. It really resonated with me, Laura, when
you said, you know, you're worried that the allied health providers aren't being
captured, um, in that aggregate data. And I think that's true. Probably in. I haven't worked in a million schools,
but I've worked in a few, um, and I think that that's generally true for us as well. Like, we aggregate big data
around curriculum content areas. Uh, but even though speech
language pathologists as allied health providers are part of that
shared, Mission for our students. Um, we're not necessarily
captured in that data footprint. So I think it's a really, I mean, I've
been, as you've been talking, I've been reflecting, you know, on all of the
systems where I've worked and just kind of what was my larger data footprint outside
of my individual client interactions. And I've got to say, like, I don't, I
don't think it's much, if it's a footprint at all, it's a very tiny, faint footprint. It is, it is not a big, robust footprint. Yeah, I think even just starting
there and saying, how does my work show up and what informs. My company, my business, my school system
of what I'm doing, if it's working or how I need resources is a question we
all need to be asking in the workplace. So, um, aside from continuous quality
improvement, I think it also that's part of that is resource needs. So if you're not capturing data
when you do or don't have resources, there's no, there's no tool to help
your leadership get them for you. A hundred percent. A hundred percent. I agree with that. And I think this is also making
me think about the technology that we interact with in terms of
leveraging the data we collect. So on this podcast, we talk a lot about
how data is not scratch, you know, tally marks on a sticky note because
that sticky note is going to end up in the trash or it's going to end
up, it's going to end up somewhere. You mentioned earlier. EMRs, right? So I'm thinking about my own practice
and the different EMRs that we've had exposure to and how some of
them capture information and some of them don't capture critical
information and how different they are. What can you tell us about leveraging
software, technology, Interfaces, other, other aspects of logistics
and infrastructure that might be really important to think about in
terms of how we improve our digital, our data footprint, you know, for
those of us who may be, I don't know, aren't maximizing those tools. Yeah, so I think speech
therapists, we type a lot. And I used to lead or manage a team
of clinicians who really got used to using smart phrases where you
would just dot and put in all your information or copy of your word
documents, and I think that's everywhere. What you're accidentally doing is
you're taking away your digital footprint because you're not asking
the software company to embed. the information in the,
um, in, in the tool. So very basic. I give a, an eat 10 with all of my
patients, which is a, a, uh, patient, um, reported symptom questionnaire
of how you're doing with swallowing. It's pretty standard in
adult swallowing care. Um, and If you get a score above three,
you should get a dysphagia diagnostic. You should get an instrumental, but
if I'm putting in a smart phrase and there's nowhere for a data capture to
pull that from a query from where it pulls boxes and information, I can never
show that my outcomes are good when my patient scores go from 30 to two. So when we use these tools or we have
these new things or these new scores and You really should be strengthening your
connection to the software companies, to Cerner, to Epic, to Meditech, to
say, I need this embedded because they're waiting for consumers to say,
everything seems good in allied health. You know, you all aren't asking for much. And as I started asking questions to
get these built in, I found myself in places like the Cerner think tank. We use Cerner where, um, they would
say, okay, well, if you need it, we're going to put we're going to
put this need on a message board. And if this need is
recognized across the country. We're going to vote it up, and then
we'll start building it, and then we'll put money into coding it, and
then eventually we're, we're going to get this in your update, right? Gosh, that process takes so long, but
that in and of itself, if all of us all over the country and our own learning
health systems are making steps to ask our software companies to put these things
in, we all are moving forward with the, um, Uh, data into a technical highway
infrastructure building, uh, across the country because it makes you feel small. You feel small when you start thinking
about this, we'll get somewhere, but what if we all just did it? I also make, I want to make the
comparison when you say we feel small. I have done that. We use an EMR and they're very, you
know, their customer service is like, Oh, well, if you want a feature added,
you know, just, you know, Send us an email and you're like, it kind of
feels like calling the cable company and being like, have a problem. And like, they don't care about me. You know what I mean? Yeah. But I think, I think what's interesting
about this particular suggestion is that a lot of these message boards are public. They're public. So if you are asking for a feature or
you want some specific measurement added, or you want a specific phrase added,
and you do Post it on a message board or you post it in like a general forum. You can also show your request
to your administrator and say, look, this is important to me. Even if so, even I guess what I'm saying
is even if the big EMR company, you feel like a tiny fish in a big pond and Oh,
what is my tiny request going to do? You know, you can still show your needs,
your documentation, because that's data. Yeah. The fact that you asked. For something is a data point that
then you can go to your administrators and say, I can't do my job without X. I am advocating with software
to do X, Y, and Z for me, but there's still a footprint. Even asking is a footprint is my point. Have you all ever worked anywhere
where, essentially, the, the company's documentation for speech
therapy looked like a Word document? It looked like a Word document,
but then, I mean, it was just basically like free type. And then it just was saved in the dark. And to me, that, that
is, that is very scary. Because it is not connected to a nurse
screening or a parent questionnaire, and there's no information guiding
should this person be in or out. And when you look at the big machine
of health care and, you know, education is a little bit different. I'm the daughter of two educators,
so I like, I'm with you just sitting in a different table. Um, but I, um, I think when you think
about it, patient health care, quality and safety really is a new is a new field. So, 20 years ago, they published the
book to air as human, and there was recently an update on it of have we
moved the needle at all because really, when you look at the quality data, you
see that we've become more aware of the health care acquired conditions. But they theorize that the, uh,
data capturing tools and what we're, what we're doing to show improvement
is still not hitting the mark. And when you look at where
healthcare often has to first get it right, it's nursing practice
because they're the biggest body of healthcare and then it's the biggest
footprint on caring for people. Um, so just because we are a smaller
subset, I think that we as allied health professionals can have a bigger imprint. On what happens with people
in our communities, if we start pushing into these. bigger systems, or like you said, even
our local EMR, just getting something updated in our local version of the EMR,
because you can start showing your worth and you start showing your improvements. You start showing your value. So my Traik team, we're through
our first cycle and saying, we're going to do these four things. And now we need a form. We need a way to document We need a
way to document and pull this patient's discharge was impacted by our rounding. We need a way to better document the
materials that were different in their care for setting them up for discharge. So that right there is embedding you
more in the multidisciplinary team to show your worth, your value, and will
future proof you when insurance companies start looking at what things impact care. I love, I love all of this. I guess I have a question that's
maybe bringing us way back to the beginning, but I'm thinking about, I'm
thinking about my actual workplace. I'm wondering about listeners who
may also be feeling like they want to get started and do something. And I had a question around the work
that you've done on your trach team. How do you, so knowing that there's so
much information out there, there's so much research, um, and staying on top
of that research as a clinician is. is impossible, right? So when we, when you first started
meeting as a group, how did you filter through all of the information that was
out there in terms of best practices to figure out what the changes were? That you were going to make like
is, do you have any helpful tips for people who are sort of feeling
like information overwhelm? So i'm going to give it a different
example because once I started to learn about learning health systems I realized
my team was accidentally already in a lot of learning cycles and then I put shape
to it so My team a few years Go really, we were at a standstill with evidence
based practice and implementation. We were not aligned. We didn't have a good foundation. Um, so what we did is we broke out into,
um, I think, 12 evidence based practice groups where you were tasked with 1
question and you were to look at the literature and you were to look at what
we were doing and make recommendations. Back to the team. So that plan do. And then we're trying to
figure out what to do. So we brought all this back to the
team and said, these are the simple changes we're going to make and
we're going to put them in place. And then we're going to see how we feel. And the good I, the thing about that is. We were presenting so there
was opportunities for feedback. There was opportunities for questions
that, um, whole concept of moving together, not informing and telling
what to do is really important here. So, I challenge everybody who's having
journal clubs and in services to start taking the shape of the cycle. We're not here to just. Client, we've identified
this as a challenge. We are here to leave
with actionable steps. And then the follow up is going
to be, how did it work for you? And is there anything bigger we can
do to improve the systems that we work in journal clubs are things of
the past actionable learning cycles. Is where we need to be pushing. I hope that helps to. Yeah, I love that. I think, I think that really is, I
mean, that really is the key difference is that it's gone from gathering,
gathering, gathering information and the gathering and sharing of that
information is the focus to gathering information in a focused area with
the actual goal, not just being sharing that information back out, but
collaboratively developing action steps. That are informed by that information. Yeah, I love I love in services and learning
about something very different. So, I think the learning cycles,
or the learning health communities should really be focused around. This is intentional work to improve
what we're doing and make our footprint better because I have suspicions. If we avoid this type of work. It's going to have tangles
with compensation, with job satisfaction, with resources,
because we're not showing our value. So, this work is more important
than ever, and I hope you guys join the learning health, uh, movement. Well, after this, I'm not
sure we have a choice. I feel, I feel very compelled. You at least take a, you know, do some
of that self reflection, reflect on some of those foundational things, the
culture of your work environment, the infrastructure that already exists, the
support that you might have of leadership, the conversations you can have with your
leadership to shift some of that support. And how, what small steps you might be
able to take to demonstrate your value, increase your data footprint, and kind of
implement some of these systems change. Yeah, and I think it also brings forward people
who have really good ideas that might not be in a place that they could share
them when you start parsing out this work and putting intention for improvement. So you're already getting ahead
of some of the things that plague our toxic workplaces, right? That there's these hierarchy of
information that has to go to leads and then bosses and then this. If you're just taking ownership that
I'm in this role to improve where I am, and I am appreciated and respected that
I'm going to do this work and it's going to inform a simple change in practice. Man, that feels good. And, um, you know, I think the second
example of having the teams break out and improve, take a look at one
thing specifically to our practice. So, um, we had, we took a close
look at spinal cord injuries. What we do. The question is, what do you do
with an acute spinal cord injury? What do you do? So we tasked a group
to take a look at that. We came up with recommendations,
simple practice changes. And when you break it up into bite sized
things, Once you get those improvements going, that existential feeling of we
have so much to do in this workplace starts to get smaller because you have,
you are trusting your, your team, your learning community to help improve your
practice because we cannot do it all. When you look at the, please
Google, the learning health system cycle, it shouldn't be one cycle. It's turned into a tornado, so we all
need to be cycling at the same time. I need my airway people. I need my literacy people. I need my pediatric people. Everybody doing learning cycles to improve
the field of speech pathology together. And quit giving it to the, The meccas
are the research places, I mean, inform them, but they're not going to save you. So I love that. And usually we end our episodes with final
thoughts, but that was just so beautiful. I'm not even, do you have
anything else to add? That was very inspiring. Um, and I, No, no, I mean, I want to hit
on that high note, but, um, this is this is truly the foundation for innovation. This is where we change our field. Um, it is it is continuous
quality improvement where you are. And when you can get that just concept
embedded in your workplace, no matter what system you work in, if it's good
or bad or challenge, you're going through a merger, just tough times. You have a pocket of growth and
that, that helps to give you, um, some of the feelings of why you,
why you entered this field back. Thank you so much for being here
and teaching us all of this. I am feeling like I have a lot of, I have
a lot more work to do than I thought. My own practice, um, but this
was really, really wonderful. Thank you so much for sharing your time. I feel very inspired. Amy, I'm sure you do too. Yeah, I do. I do. I'm energized about it. Thanks for having me. Thank you. Thank you so much for joining us
in today's episode, as always, you can use this episode for ASHA CEUs. You can also potentially use this
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