WebM&M teaches by example with case studies: site draws quality managers, safety professionals

HealthCare Benchmarks and Quality Improvement, Nov, 2004

"One of the great challenges in the whole world of quality and patient safety is learning to take advantage of the richness of clinical cases," says Robert M. Wachter, MD, professor and associate chairman in the department of medicine at the University of California, San Francisco (UCSF) and chief of the medical service at UCSF Medical Center.

"It's a great challenge whether you are a doctor, nurse, risk manager, quality leader, hospital CEO, or a therapist," he says.

Wachter says he is beginning to believe that AHRQ WebM&M (http://webmm.ahrq.gov), an on-line journal (of which he is the editor) and forum on patient safety and healthcare quality sponsored by the Agency for Healthcare Research & Quality, is accomplishing just that.

Launched early 2003, WebM&M features:

* expert analysis of medical errors reported anonymously by readers;

* interactive learning modules on patient safety ("Spotlight Cases");

* forums for on-line discussion.

"It's grown incrementally over time, exceeding expectations," says Wachter, who notes that there are about 7,500 registered users and 700 unique visitors to the site daily. What's more, he notes, the average visitor stays on site for 12 minutes, "so it's likely they're reading the information," he observes."

This seems to indicate the site has achieved one of its primary goals, which was to make its case commentaries relatively brief and nearly jargon-free. "We did not want it to feel plodding and academic," Wachter explains.

Patrice Spath, of Brown-Spath & Associates in Forest Grove, OR, also is impressed with the site. "What makes it different from many other health care-related web sites is that this one is specific to what the healthcare professional needs to do to improve patient safety," says Spath, who serves on WebM&M's advisory board.

"It is constantly updated with new ideas, and has a high caliber of advisors. Also, there's a very systematic, scientific analysis of the incidents they present--not just random commentary," she continues.

A tremendous epiphany

In numerous discussions with healthcare professionals, Wachter had noted a common theme.

"What I would hear as we'd go from hospital to hospital is something like this: 'We had this particularly troubling and interesting case, but we can't even figure out how to get the information to our other units or departments,'" he recalls.

"AHRQ's and our epiphany was that there is a tremendous richness in clinical cases, but no one had figured out a way to present them as real, and in a manner that was accessible, lively, and useful. I honestly don't think anyone else does it," Wachter explains.

By using the web interface, people can send the site cases anonymously from anywhere in the world, he notes.

"Through AHRQ's resources, we are able to compensate case submitters, which gives them an incentive to submit and enables us to engage the world's experts," Wachter says.

So, for example, if a case is submitted on a medication error, or on wrong-site surgery, when staff consider who the best person would be to provide expert discussion and commentary, they usually can get them. "Plus, we have a strong editorial team, and all cases read well and in an interesting way," Wachter adds.

"We work hard with the authors to be sure they are as engaging, as practical, and as interesting as possible," he says.

Quality managers taking advantage

While WebM&M originally was oriented toward physicians, a survey this past May indicated the following breakdown: 24% were nurses; 21% were physicians; 4% were pharmacists; 11% were healthcare administration/managers; and 32% fell into a broad category that included quality managers, risk managers, systems engineers, and ethicists.

"It was equally split between providers and nonproviders," Wachter notes. When asked to rate the educational value of the site, 75% of the respondents rated it as "excellent."

There are many ways quality managers can and should use the site to improve performance, Wachter says.

"For one thing, this field is so broad I don't think anyone knows all they need to know," he asserts. "The average quality manager or leader or risk manager will learn from the site because the cases we've posted range from psychiatry to surgery and safety problems, and from wrong-site surgery to errors related to implementation of IT to cognitive psychology and teamwork."

Just as importantly, Wachter says, it can be used to spread education across hospital silos.

"Many [quality managers] have taken to sending an issue or an individual case and mailing the web link to a doctor of nurse on the patient safety committee, because they believe they can learn from it," he notes. "Then, somebody who might not have gotten the journal might pick it up and then be hooked."

Each month, he explains, there is a "spotlight case" presented with a PowerPoint slide set. "Many people use that as a way of starting each month's quality or patient safety meeting; if you're looking for teaching materials, we've done some of the work for you."