Editor’s note: First published on The Hospital Leader blog under the title, “How I Realized QI Could Be a Dirty Word.”
With the recent election, there has been a new recognition of the various “bubbles” we all seem to be living in. It reminds me of the parable I like to, popularized by the late great writer David Foster Wallace: Two fish were swimming along when an older fish swam by, nodded his head at them and said, “Mornin’ boys, how’s the water?” The two young fish nod back and swim for a bit, then one turns to the other and says, “What the hell is water?”
Imagine the hard reality that hit me when I read this quote from a resident: “Truly, the first thing I think of when I hear [QI] is going to make more work for residents.”
Wait – is QI actually a dirty word for other residents and physicians?
The quote comes from an Academic Medicine titled “ ‘It Feels Like a Lot of Extra Work’: Resident Attitudes About Quality Improvement and Implications for an Effective Learning Health Care System.” I read on, and it got worse.
“This hasn’t really made any difference to the patients. Like this checklist we do on rounds, like I don’t know. Maybe it has.”
And, by far, most concerning: “There’s like the central line protocols … If you suspect that anybody has any type of bacteremia, you don’t do a blood culture; you just do a urine culture and pull the lines … we just don’t even test for it because the quality improvement then like marks you off.”
That is some harsh truth about unintended consequences right there. (Also, apparently us kids of the 1990s still say “like” a lot, which is, like, not very professional and also like kinda grating.)
The residents in this study were from the University of Utah, Salt Lake City – an institution I frequently– and publicly – admire for their incredible progress on systematically introducing into their practice.
What can we do?
Read the full post at hospitalleader.org.
Also on The Hospital Leader…
- THIS Is What Teamwork Looks Like, Danielle Scheurer, MD, MSCR, SFHM
- The Medicaid Overhaul and How Hospitals and Their Providers Could Be Hardest Hit, by Brad Flansbaum, DO, MPH, MHM
- Count Me – and My Intuition – In by Tracy Cardin, ACNP-BC, SFHM