Independent Medical Reviews
October 22, 2018
In this week’s excerpt from the leadership roundtable discussion, we pick up with an examination of what “quality” means. The following is from a leadership roundtable discussion in which we explored Advanced Medical Reviews’ belief statement- we believe every patient should receive quality healthcare.
Read more from the AMR leadership team- Leah Williams (Manager of Recruitment and Credentialing), Emir Rubi (Operations Manager), Stephanie Nguyen (Operations Manager), Nora Kleiman (Operations Manager), Natalya Dawkins (Director of Client Success), Lu Crowder (Clinical Quality Director) and Megan Kaufman (General Manager).
Megan: One of the key words is quality. It means patient safety, on both ends of the spectrum. Making sure patients are getting care that they should be receiving and also making sure that they are not getting treatments that are not necessary or potentially harmful, even. It means there is a time element in quality, as well. It doesn’t help to be making decisions that aren’t timely.
There is also an aspect of communication in quality. Are decisions being communicated in a way that is clear and supportive? Going back to our pillars of our reviews, “quality” depends on both evidence-based medicine and also on the specifics of every patient. I think “quality” can mean a lot of different things to a lot of different people, but it means ALL of those things, not just one aspect of it.
Leah: Working at AMR has fundamentally altered my outlook on healthcare solutions. Earlier in my career, I recall taking a strong stance on healthcare equality. Having matured in the industry, I no longer believe that healthcare equality is the most effective approach because equality doesn’t always leave room for individualized care.
I think the magic word is equity; every patient gets the most appropriate care at the most appropriate level, and at the most appropriate time. Healthcare equity is ultimately what AMR’s efforts contribute to.
Emir: I think that’s an important point in the belief statement. We have both an individual factor, but also a more general one. For me, one of the most salient examples has been genetic testing for breast cancer patients. In the last two or three years, there have been very significant changes in the way some of those requests are looked at, to the point where, now, some of the requests we used to review as investigational treatments, are no longer considered investigational to the same extent. That is a quick change. Having seen a lot of those individual cases come through and now seeing that the larger context of healthcare around those individual services has changed so much, I think it goes to show that both ends of that spectrum are represented well in our belief statement.
Nora: One thing that came to my mind in thinking about this was my place as a leader within the organization and making sure that our team really understands what quality health care can mean. Using my own personal experience, working on cases that are denials has the potential to weigh on the spirit when there is genuine desire for making a difference, particularly if that connection about our role in the industry hasn’t been made. I think understanding, like Emir was saying, what AMR’s role is in the larger healthcare system has brought a lot of meaning to my work.
Natalya: In my work, I focus on our clients’ feedback and being very responsive to that. I believe that patients and families know quality care when they experience it. From a physician’s bedside manner to the hospital’s cleanliness or atmosphere – each of these affect how people feel about the quality of their healthcare. I view AMR as an extension of that because we care about how we treat people as we go about providing reports about the appropriateness of a patient’s care.
Also, Megan mentioned that there’s an element of time in quality and I couldn’t agree more. When we are timely with our response, reducing waits and potentially harmful delays, we provide quality healthcare to patients. And furthermore, the fact that ‘we believe that every patient should receive quality healthcare’ means that quality is steady and unwavering; it does not fluctuate due to personal characteristics like ethnicity, gender, socio-economic status or geographic location.
Stephanie: Our healthcare is an ecosystem. We have patients, providers, health insurance companies, government, pharmaceutical companies, etc.. Each player is integral to reforming and improving quality care. Quality is understanding each player’s perspective and role because they all impact patient care. For example, understanding our relationship with patients and our client’s relationships with patients allows us to make the right decisions and work towards solutions that positively contribute to this ecosystem. We have a great team of staff and technology, but that alone does not drive quality. The magic happens when we collaborate and share perspectives. It takes a village to provide quality healthcare.
Lu: My personal and leadership values are to treat people the way I would want to be treated, always respecting each person’s cultural values and preferences. As we review each health care service request presented to us and the scientifically validated guidelines that apply to it, our mindfulness of the human being at the center of the request helps us focus on making the most well-supported recommendation we can make in each case.
Nora: For me, as a leader here, one of the things I think is very important is for me to help our team understand just how important their individual role is in making sure that they understand what part of the process they are contributing to for each and every patient. We all play our part, and we want to make sure we are doing it right.
Megan: To build on that, the thing that I’ve learned with AMR is that there are so many people in the broader healthcare industry that genuinely want to do the right thing and want to make sure that, wherever possible, people are being treated and cared for well. Even on the administrative side, people really do have a passion for that. I think that surprised me a little bit because there is a tendency to think of the administrative side as being very business-oriented and bottom-line oriented. I can’t even count the number of times I’ve had conversations with people where, at the heart of what they are trying to do, is what we believe, as well. I think that is very reassuring; that we all share a belief that every patient should receive quality healthcare.
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