SHM: BEHIND THE SCENES

Resolutions

By Tina Budnitz, MPH

This is the time of year when many New Year’s resolutions dissolve. In some cases, people set unrealistic goals. Others lack the tools to succeed or live in an environment that makes change too difficult. In 2006 I resolved to start running each morning before work. I have the determination and the physical ability to meet this goal. Disarming the house alarm at 5 a.m., however, awakens my two toddlers. And detaching two toddlers from my legs proves to be quite a challenge. It also turns out that my tolerance for cold weather is low, while my ability to forgive a missed run is high.

Sustaining quality improvement initiatives at the hospital is lot like sustaining New Year’s resolutions. The best of intentions are often thwarted by a lack of time, resources, or energy to change the system, as well as by those within the system who resist change. For example, SHM members tell me that attempting to introduce a new discharge planning process feels a lot like trying to run through the hospital with two toddlers hanging on to your legs. SHM strives to support hospitalists in their resolutions to implement positive change in the hospital.

My role at SHM is to lead the development of programs, tool kits, and support mechanisms that will enable you, our members, to implement and sustain local quality improvement efforts.

SHM currently supports members in their efforts to improve outcomes for patients with heart failure, stroke, or diabetes; we work to prevent venous thromboembolism (VTE) and hospital-acquired blood-stream infections. We also support members in their efforts to improve the discharge process for older adults, thereby reducing readmission rates and adverse drug events while improving communications with receiving physicians.

We support members in their efforts to implement, evaluate, and sustain QI initiatives using a variety of methodologies. We offer symposia, workshops, and a full-day Annual Meeting Pre-Course on quality improvement; we also provide Leadership Academy Level I and Level II and networking opportunities for members and their mentors. We’ve designed Web-based clinical tool kits around specific disease states and special patient populations. We offer Web-based resource rooms to guide members from start to finish through a new local QI initiative. We have funded demonstration projects to pilot new approaches and tools for use in discharge planning, along with innovative research to improve care for heart failure patients. And we’ve only just begun.

Researching the Approach

For each QI area we address, an advisory board is recruited to represent the best available experts, organizations, and multidisciplinary professionals. For example, the Discharge Planning for Older Adults Advisory Board includes representatives from the American Geriatrics Society (AGS), the Institute for Healthcare Improvement (IHI), the Agency for Healthcare Research and Quality (AHRQ), the Society of General Internal Medicine (SGIM), the Case Management Society of America (CMSA), the National Quality Forum (NQF), and the Association for Health-System Pharmacists (AHSP), in addition to nationally renowned leaders in care transitions, geriatrics, nursing, patient literacy, and pharmacy.

Each Advisory Board conducts a needs assessment and a review of the literature to examine interventions and approaches. The board identifies existing “gaps” in clinical tools and guidelines. Finally, the Advisory Board determines specific, measurable targets for a hospitalist-led intervention and suggests the evidence-based approach(es) that should be most effective.

Implementing an Intervention: Where the Rubber Meets the Road

As I pointed out earlier, resolving what should be done and getting it done are two very different things. In most cases, few people debate the need for the intervention—reducing the incidence of inpatient VTEs, for example—or the validity of the proposed intervention. The challenge arises in changing the system of care so that the intervention becomes the new standard of care. Therefore, after the Advisory Board has determined the aims and intervention(s), SHM develops a “workbook,” a step-by-step field guide for hospitalists that walks them through the process of building a project team, establishing project aims and key metrics, obtaining institutional support, planning the intervention, launching the intervention, measuring impact, and sustaining system improvements.