Quality-improvement (QI) initiatives should be viewed through the prism of systems change, not just as one-off checklists that show some uptick against core measures, says a researcher whose work was published in the Journal of Hospital Medicine this month.
Ted Speroff, PhD, professor at the VA Tennessee Valley Healthcare System's Center for Health Services Research, led a team of researchers who found that using a collaborative approach to preventing central-line-associated bloodstream infections (CLABSI) and ventilator-associated pneumonias (VAP) worked better than simply using toolkits.
The study, "Quality Improvement Projects Targeting Healthcare-Associated Infections: Comparing Virtual Collaborative and Toolkit Approaches," found that 83% of ICUs using the collaborative approach implemented all CLABSI interventions, versus 64% of those in the toolkit group (P=0.13). The study further reported that 86% of the "collaborative group" implemented the VAP bundle, compared with 64% of the "toolkit group" (P=0.06). There was no statistically significant difference in patient outcomes.
"The key point is that quality improvement has a cultural and psychological component to it," Dr. Speroff says. "It's not just a task force of a subcommittee that you set up to achieve one tactical objective."
The study refers repeatedly to continuous quality improvement (CQI), which Dr. Speroff says HM leaders are in position to spearhead as many hospitalists already are viewed as QI leaders in their institutions.
But reform can only happen if HM and other specialties buy into the concept, and administrators don’t view it in terms of purely a cost-benefit analysis.
"There has to be a will to go that that road or some sense of urgency," Dr. Speroff says.