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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?
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'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.
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