Presenters: Michelle Mourad, MD, director of quality and safety, UCSF School of Medicine, San Francsicso; Nasim Afsar, MD, associate chief medical officer, UCLA Hospitals, Los Angeles
“The goal is to inspire the to believe what you believe,” urged Dr. Mourad, who, along with her co-presenter, Dr. Afsar, outlined the steps needed to create a successful QI project. The steps for a successful QI project should include the following:
- Understand the problem. Often a fishbone diagram can be created while brainstorming about why you have the problem.
- Convince others there is a problem. “Every project needs a sense of urgency,” stated Dr. Mourad. Engaging others in your organization in the problem often requires appealing to both the analytical and the emotional sides of the brain. “Find the patient stories that move you.”
- Identify areas for improvement. This often will require a prioritization matrix. Starting with high impact/low effort aspects of the project may be appropriate.
- Prioritize small tests of change. Aims must be attainable, as unattainable goals may be discouraging when they are missed.
- Devise a measurement strategy. Collecting data is challenging but will allow you to ensure the problem you are fixing will result in improved outcomes.
- Measure change. This can involve measuring outcomes, processes, structure, and possibly balancing measures (unintended consequences). Integrate measurement into a daily routine, and consider using data already being collected if this is easier.
- Sustain the change. Coaching can improve motivation to continue the QI effort. Track improvement using statistical process charts, and celebrate success. Creating and referring to readily accessible data will help put process ownership into the group.
QI is a four-legged stool, concluded Drs. Mourad and Afsar: education, data audit and feedback, systems change, and culture change. TH
Dr. Chang is a pediatric hospitalist with the University of San Diego Medical Center and Rady Children's Hospital, San Diego, and the pediatric editor for The Hospitalist.