Using Quality Improvement Frameworks and Methodologies to Improve Clinical Outcomes

Background: Medical error has become the third leading cause of death in the United States (Makary & Daniel, 2016). While most clinicians are familiar with studies that report the magnitude of healthcare errors, many don’t have adequate training and sufficient resources to evaluate and solve a quality problem in one’s practice environment. Clinicians receive varying levels of quality improvement (QI) methodology training during their formal education and even schools that incorporate QI do not spend adequate time in teaching specific tools and techniques. Most importantly, QI requires hands-on experience to master techniques, which is often difficult to do during formal training. To bridge the gap between clinical practice and high quality and cost-effective care, a program for QI was designed in a large academic center to address this need. The QI Scholarship Program, as it is formally known, enables each clinician to design a project focused on their own clinical environment aligned with departmental and service-specific priorities. The scholars that are selected are trained to apply knowledge and methods of health care QI to the care of individual patients and populations.

Implementation: The call for applications is sent out annually in the beginning of the academic year. Interested individuals are asked to apply by a predetermined date in early fall. The application includes the scholarship award amount, training schedule, important due dates, and list of departmental and service-specific priorities. Each year the program selects six to ten clinicians from the application pool. Each scholar is provided training on QI methods and tools that facilitate evaluating an underlying problem and improving health care processes and outcomes. The program provides longitudinal mentorship and monthly check-in points to ensure ongoing progress with individual projects. At the end of the academic year, the scholars are required to present their projects in a podium or poster presentation.

Evaluation & Outcomes: The QI scholars are trained to systematically analyze practice using QI methods and implement changes with the goal of practice improvement. The Model for Improvement and Plan-Do-Study-Act (PDSA) is introduced and progress is tracked through the A3 tool. All Scholars projects are collaborative and interdisciplinary in nature and are completed by academic year. During the program, scholars build teamwork skills and develop a personal sense of responsibility for their population. At the end of the program, scholars present their projects to their peers and colleagues at different hospital committee meetings and conferences.

Impact & Lessons Learned: The QI Scholarship program is extremely popular and feedback from faculty and clinicians is overwhelmingly positive. Numerous outcome measures have been achieved including new assessment and management of pain on the inpatient medicine units, wellness retreat for staff, and creation of clinical pathways. There are many valuable lessons that have been learned along the way, including involving leadership from the onset, establishing a clear vision and objectives, ensuring the right QI tools are implemented, creating a burning platform to engage others, sharing information with stakeholder in a timely manner, guaranteeing there is a mechanism for project sustainability and remembering to celebrate successes.