Training Is Necessary
QI and patient-safety methodologies have become sophisticated disciplines in the past two decades, Dr. Wright says. Access to training in QI basics now is readily available to early-career hospitalists. For example, CogentHMG offers program support for QI so that anyone interested “doesn’t have to start from scratch anymore; we can help show them the way and support them in doing it.”
This month, HM13 (www.hospital medicine2013.org)—just outside Washington, D.C.—will offer multiple sessions on quality, as well as the “Initiating Quality Improvement Projects with Built-In Sustainment” workshop, led by Center for Comprehensive Access and Delivery Research and Evaluation (CADRE) core investigator Peter Kaboli, MD, MS, who will address sustainability.
Beyond methodological tools, success in quality and patient safety requires the ability to motivate people, often across multiple disciplines, Dr. Nagamine says. “If you want things to work better, you must invite the right people to the table. For example, we often forget to include key nonclinical stakeholders,” she adds.
When working with hospitals across the country to implement rapid-response tTeams, Dr. Nagamine often reminds them to invite the operators, or “key people,” in the process.
“If you put patient safety at the core of your initiative and create the context for that, most people will agree that it’s the right thing to do and will get on board, even if it’s an extra step for them,” she says. “Know your audience, listen to their perspective, and learn what matters to them. And to most people, it matters that they give good patient care.”
Gretchen Henkel is a freelance writer in California.
Branch Out: QI and Patient-Safety Initiatives
Pick a passion. It’s best to choose an issue that’s important to you. “It has to be a
passion because much of the time it’s an uphill battle,” says Dr. Gundersen. She started with the issue of reducing readmissions, and with two colleagues pitched the idea of involving the UMass HM group in SHM’s Project BOOST. After that, she set out to become an expert on reducing readmissions, applying what she had learned to other successful initiatives.
Learn the lingo. Dr. Wright advises learning some of the most basic principles, such as Shewhart’s PDCA (Plan-Do-Check-Act) or Deming’s adaptation PDSA (Plan-Do-Study-Act) cycles; the quality tripod; and accessing resources made available from SHM. A member of SHM’s Hospital Quality and Patient Safety Committee, Dr. Wright says a subcommittee for leadership engagement has been created and furnishes tools and training for advancing quality initiatives. The Institute for Healthcare Improvement (www.ihi.org) also offers a wealth of measures, speaker series, and white papers on improvement in health care.
Start small. You can test your ability to work with interdisciplinary departments, often a prerequisite of many quality initiatives, by first joining a committee, Dr. Nagamine advises. “See how effective or persuasive you are in pitching an idea and seeing it through with other departments,” she says.
Brace for a marathon. “Most people,” Dr. Gundersen says, “do not hand you 100% of their cooperation and a budget you can work with.” It takes time to get buy-in, especially if you’re doing interdisciplinary initiatives. If possible, break your projects into achievable units. “Start with some quick wins. Small payoffs here and there can re-energize your team and eventually yield a larger payoff,” she says.
Limit sweat equity. It’s important to put in time at the start of a project to demonstrate your value, but if you’re constantly staying up late working on a project, consider pitching a compensated role to your boss. “Being a good citizen and volunteering for committees is one thing,” Dr. Nagamine cautions, “but taking on leadership roles in too many projects, without dedicated time, is not sustainable and can jeopardize the success of your projects.”
—Gretchen Henkel
