Quality improvement project
- Evaluate and implement systems improvement based on clinical practice or patient and family satisfaction data; in personal practice, team practice, and within institutional settings.
- Engage in a process of rapid-cycle improvement.
- Reflect upon the benefits and challenges that rapid-cycle quality improvement projects present.
Lynn J et al. (2007) Basics of quality improvement. The Common Sense Guide to Improving Palliative Care. (pp. 21-40) New York: Oxford University Press
- Quality Improvement Initiative is introduced. Fellows brainstorm, develop their aims and plans.
- Fellows meet to share their ideas and plans (5 min each).
- Meet with assigned faculty to review their ideas and proposed implementation. Fellows enact their plans and measure results
- Fellows meet to share an update on their project (5 min each).
- Fellows present their results and receive feedback.
High-quality delivery of care depends upon regular assessment, identification of barriers and deficiencies, and rapid institution of improvements. The steps involved in rapid-cycle quality improvement have been proven to yield positive results when implemented by motivated teams. On a smaller scale, individual practitioners can also take advantage of this technique to reflect upon and improve their own delivery of care.
We will cover the following topics in our introductory session (40 minutes):
- Previous experiences with quality improvement initiatives: What was helpful and what was difficult about them (10 minutes)
- Introduction of the fellowship quality improvement project and how to choose a project (10 minutes)
- Review of rapid-cycle quality improvement (15 minutes)
- How to define an effective aim
- The Rapid-Cycle Improvement Process: PDSA
- Questions and plan for follow-up (5 minutes)
Project enactment should take place in November and December of the academic year. Each fellow should seek guidance from his/her faculty mentor.
- Step 1. Plan: Defining the problem, choosing an aim, describing possible changes, and defining appropriate measures.
- Step 2. Do: Enact the plan and measure outcomes
- Step 3. Study: Data is collected and charted.
- Step 4. Act: Think about ways that the changes can be adopted more ?globally? (if successful) or consider ways in which the project enactment can be improved (if unsuccessful)
The goal of this project is to practice the skills involved in rapid-cycle quality improvement, not to make major system changes in a large academic medical center. By focusing on individual practice, we hope to introduce basic QI concepts without getting fellows enmeshed in complicated organizational dynamics. The focus of each project should be on behaviors and practices that the individual fellow can enact, rather than depending on the behaviors and practices of others.
Example projects may be:
- Increasing the number of bereavement phone calls to families
- Improving sign-out to night-time and weekend coverage
- Improving documentation of opioid use for patients using PCA?s
- Improving one-on-one teaching with rotating housestaff
By the end of the process, each fellow should have a summary of his/her own quality improvement project. The summary should include the following:
- A description of the problem
- A clearly defined aim
- A brief description of the changes to be made
- A description of the measures to be used
- A time-series graph highlighting major changes and results
- A brief description of possible future interventions, based on the above results
- A brief description of the 'lessons learned' from this rapid-cycle QI process
Palliative Care Policy Center (a compendium of useful resources and books about quality improvement)
ACGME Outcomes Project (description of ACGME required competencies and Outcomes Project, including Practice-based Learning and Improvement references)