The Healthcare Matrix was inspired by the IOM report Crossing the Quality Chasm, which states that there is a chasm between the healthcare that providers now provide and the healthcare that they are capable of providing. Quality improvement specialists at Vanderbilt University Medical Center developed the Matrix, in which the IOM Aims for Improvement (identified in Quality Chasm report) are linked with the ACGME Competencies to form a 36-cell table. The Matrix guides users to scrutinize their patient care through every facet of the Aims and Competencies, thus identifying improvement opportunities. They must ask themselves whether care is safe, timely, effective, efficient, equitable and patient-centered. If for example care is not safe, the Matrix directs them to discover if it is due to medical knowledge, interpersonal/communication skills, professionalism, or system issues (the core competencies). Once this analysis is completed, they must identify what was learned from the care and what needs to be improved (practice-based learning and improvement). An important feature of the Matrix is that it forces the users to “close the loop” — if no improvements are identified on the bottom line of the Matrix, there is a glaring reminder that these problems will happen again.

The Matrix provides a systematic approach to care analysis, one that incorporates all the competencies to assess care and provides a documentation system for the residents who are the most knowledgeable of the system flaws. This tool applies to: inpatient and outpatient settings; any specialty; public health, or any venue where healthcare needs are addressed. It can be used by medical students, residents, physicians, nurses--anyone caring for patients. It is most useful for changing M&M and case conferences into improvement discussions. Aggregating multiple matrices allows analysis of care issues by individual learners, rotations, specialties, diagnosis, each of the IOM aim or ACGME Competencies. When the external measures of quality are used to teach residents, they have helped improve these metrics.

The tutorial describes how to use the Matrix as well as two QI projects that used the Matrix to improve patient care practice (ENT resident) and patient outcomes (28 medical students on their neurology rotation).

References

JW Bingham, DC Quinn, MG Richardson, PV Miles, SG Gabbe. Using a healthcare matrix to assess patient care in terms of aims for improvement and core competencies. Joint Commission Journal on Quality and Pt Safety (2005) 32: 98-105.

Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: Institute of Medicine. (2001)

DC Quinn, PhD, JW Bingham, MHA, NA Shourbaji, BS, AA Jarquin-Valdivia, MD. Medical Students Learn to Assess Care Using the Healthcare Matrix. Medical Teacher. (accepted for publication)