What is MEER?
The basic premise of MEER
Map-enabled experiential review – or MEER – is an innovative technique that re-purposes tools commonly used in process management for use in quality improvement or evaluation.
The premise on which the MEER approach is based is very simple. The key question in any quality improvement or evaluation endeavour is “how can we do this better?”. But to answer this question, it is necessary to first ask “how do we do this now?”
The importance of the frontline perspective
The people at the front line of any process are the ones who really know what actually happens in routine practice. Therefore, the core activity of quality improvement or evaluation should involve frontline people reflecting on daily activities.
In a team-based workplace (such as healthcare) these reflections are most usefully undertaken as a team. However, without structure, these conversations can become aimless and unproductive. Indeed, a systematic approach to process improvement activities is considered the most effective strategy for reliably identifying the source of problems.
How does MEER add value?
MEER is a systematic approach, using graphical models, or maps, of process systems to enable structured conversations within teams, drawing on the knowledge and experiences of frontline people as the basis for a review of how well those processes are being implemented.
The outcomes of these structured conversations serve as an evidence base for an improvement action plan. The structured conversations are engaging and educative for participants, who also develop a sense of ownership of the resulting action plan.
Where can MEER be used?
Using the MEERQAT app, the MEER approach can be used by any organisation, big or small, private or public, that wishes to assess, improve or evaluate its programs and processes. MEER is particularly useful for service-oriented organisations. The approach brings transparency and understanding about how complex organisational systems are working to both frontline personnel and management.
Besides quality improvement and evaluation activities, the MEER approach can be used in a range of other applications including:
- Case management and client journey tracking
- Monitoring program implementation
- Other program management tasks
Is MEER a validated approach?
The first application of the MEER approach was the implementation of the Best Practice Clinical Learning Environment (BPCLE) Framework in the Australian state of Victoria. The MEER concept was the basis of an online implementation tool – BPCLEtool – that assisted Victorian public health services and registered community health services to assess and improve their clinical learning environment arrangements against the ideals set out in the framework. A peer reviewed journal paper reporting the successful use of BPCLEtool was published in 2018. The BPCLE Framework has also been endorsed as a template for Australian national implementation in a recent independent review on “Educating the Nurse of the Future” by Emeritus Professor Steven Schwartz AM.
Subsequently, the MEER approach was tested in a clinical setting in a trial funded by a hospital research institute in Melbourne. The project demonstrated the MEER approach was well received by staff who reported increased awareness and understanding of the national standards and related hospital policies and protocols, as well as increased interest in quality issues and quality improvement. The study also revealed substantial improvement in quality and safety in the participating units, with a 34% statistically significant reduction in the recorded incident rates of the participating units relative to the rest of the hospital for a set of independently recorded incidents relating to patient identification. The study was peer reviewed and published in the BMJ Open Quality journal.
A full description of the MEER approach has been published in the international peer reviewed journal, Management in Healthcare.
WorkSafe Victoria, the health and safety regulator and manager of the workers compensation scheme for the state of Victoria, is using MEERQAT to develop logic models for a range of its programs and projects to be used in periodic evaluation activities.
Community Child Care Association
Community Child Care Association is an independent not-for-profit peak body that advocates for access to quality education and care services for children and families. They are using MEERQAT to evaluate their processes and programs.
Asylum Seeker Resource Centre (Footscray, VIC)
This not-for-profit organisation use MEERQAT as part of their quarterly reflection workshops for their program areas. Staff use bespoke basemaps to assess their progress with monitoring and evaluation plans and to identify where gaps in data collection are occurring.
Epworth HealthCare funded a 12-month research project at its Richmond hospital to evaluate MEERQAT in two clinical units. Basemaps from the MEERQAT Basemap Library corresponding to five NSQHS/Clinical Care Standards were used in the trial. The study found substantial and significantly significant reductions in adverse hospital incidents in the two study units compared to the rest of the hospital.
The cardiac catheterisation unit at Cabrini Health in Melbourne has trialled MEERQAT’s team-based approach to quality improvement in an initiative called “Quality Bites”. This approach is designed to work in a busy frontline area of a hospital, where finding dedicated time to focus on quality issues can be challenging. The unit worked though the Library Basemaps focussed on the NSQHS standards, ahead of accreditation in mid-2018.
Home Nursing Solutions
This home care provider of aged care, palliative care and disability care services in Adelaide, South Australia is using MEERQAT to assess their processes and systems against the Home Care Common Standards.
Dept of Fire and Emergency Services (WA)
The Strategic Volunteer and Youth Programs section within the department is developing logic models for a number of its programs using MEERQAT’s Basemap Builder. The resulting bespoke basemaps are used to evaluate implementation and outcomes of these programs.
Department of Health and Human Services, Victoria
The department’s Health and Human Services Workforce Branch is using MEERQAT’s Change Management basemap to assist them with review of a recent branch-wide change process.
The department is also using the bespoke MEERQAT application BPCLEtool to implement the Best Practice Clinical Learning Environments (BPCLE) Framework in all public health and registered community health services in Victoria. Private and not-for profit health services in Victoria and interstate are also using this tool.
Rural Community Intern Training (RCIT) Program
The RCIT Program is using a bespoke basemap based on the program logic model developed as part of the RCIT Program Evaluation Framework, to evaluate the implementation and outcomes of the program at five sites across regional Victoria.
Darcy Associates Consulting Services
This consulting business is using bespoke basemaps in the context of strategic planning activities and change management processes for selected clients.
Dr Donna Cohen, BSc (Hons) PhD MPPM
Donna is a researcher, analyst and expert facilitator with a passion for strategic planning, process implementation, evaluation and quality improvement.
Dr Vitas Anderson, BEng (Hons) PhD
With his background in engineering, medical physics and statistical analysis, Vitas has been a significant contributor to the development of corporate policies and international standards.
Phil Cohen, BA (Hons) MA
Phil’s extensive experience includes client relationship management, health administration, quality improvement, market and social research, medical indemnity insurance and risk management.
Annie Curtin, CCRN BA
Annie has a unique skill set that combines clinical, educational, research and administrative expertise which she has applied to a range of quality improvement projects.