Quality Improvement (QI) work requires recognition that our patient care and health systems demand constant adjustments to accommodate an everchanging landscape. Simply increasing our knowledge or skillset does not immediately translate into better patient care. We must appreciate the influence of factors within the system and its processes which enable high quality, patient centered, efficient, equitable care.
QI initiatives are laid out in a framework of planning, executing and evaluating a proposed change. QI is inherently a multidisciplinary effort that engages faculty, trainees, advanced practice providers, nurses, pharmacists, therapists and others. In many cases, QI processes may include patients and the community.
While QI is rewarding, it can also be exhausting. Increasingly, involvement in QI has become a requirement for providers and trainees alike. Without proper guidance, the team may undertake poorly designed projects that have limited impact. This failure may lead to difficulties with future Qi initiatives. Below, we offer a few tips for anyone engaging in this kind of work:
- Identify the need for change: When starting a project, focus on identifying the issue and its importance. What patient population does it affect? What are the consequences of not implementing change? Focusing on things that matter will help motivate change.
- Institutional Review Board (IRB) approval and/or waiver: Although most QI projects are not considered human subject research, some may still require IRB oversight while others may allow a waiver. Most journals will require mention of IRB approval or a waiver when publishing a manuscript .
- Choose team members wisely: Choosing a representative for each relevant domain helps to define challenges while gaining patient/family input and helps to focus on the major issues. Lastly, involving at least one participant who is hesitant to the proposed interventions or need for change is crucial as this allows insight into the opposing arguments and predict the difficulties that might be encountered. A well-functioning team should be able to provide the data and arguments, as well as compromise to ensure the success of the interventions.
- DATA, DATA ,DATA: It is important to have objective and baseline data; this can be obtained from surveys, chart reviews, literature review or other sources. Only analysis of data can confirm that there is room or need for improvement.
- Start with the drivers not the interventions: Spending time to truly understand the factors and key drivers that impact the wanted outcome is key; tools such as pareto charts and process maps are useful in this effort. It is generally recommended to limit the drivers to about three to five for meaningful impact. By focusing on the drivers first, you will avoid planning interventions that are unnecessary.
- Incorporate QI in the routine functioning of a department/team: Using QI methods to help with administrative and routine clinical tasks can establish and promote a culture of safety and transparency.
- Disseminate high quality work: Each QI project should be approached with the intent to publish and disseminate the findings. Consultation with statisticians familiar with American Society for Quality (ASQ) statistical process control charts and standards, along with traditional statistical analysis, will help provide valid robust results. Familiarity with SQUIRE guidelines will facilitate manuscript preparation.
- Enjoy the process: The tangible change and the real impact will make the process worth it. QI should be fun, motivating and meaningful.
