By Amy Short, MHSA, CSSBB, University of Cincinnati; Amanda Solis, MS, Pfizer; and Barb Speer, University of Cincinnati
The healthcare industry is changing rapidly, with systems and clinicians facing increasing-complex challenges. Simultaneously, organizations are under scrutiny to enhance quality and achieve operational excellence in the delivery of patient care. Decreasing gaps in knowledge and practice is the key to ensuring quality care, and educationalists can play a role in equipping the care team with the tools needed to succeed.
Processes used in planning and accrediting continuous professional development (CPD), such as the needs assessment, objective setting, programming, evaluation and follow-up, are similar to the rapid cycle of improvement and organizational change projects.1 CPD has an opportunity to adapt alongside these processes and highlight its role in enhancing quality care. Healthcare education professionals have vast experience in managing complex programs that involve a diverse team and require timeline management and quick execution. These skills are also essential in quality improvement (QI) initiatives.
Blending the planning processes used in developing educational programs with the rapid-fire approach to QI projects is both a science and an art. As educators, we have an opportunity to play a role in advancing the adoption of QI. At the same time, we don’t need to be experts on QI or population health in order to participate in improving patient care; we simply need to know who to get involved with and form partnerships while utilizing our vast skill sets. We need to be willing to be team members and accept that we may not always be in the driver’s seat.
When we developed our Alliance session last fall, our goal was to offer a look behind the curtain on a QI project that was executed by an interdisciplinary team that included CPD professionals and present the real-world challenges that we faced. This article highlights some key insights from this project.
QI Deep Dive
QI is increasingly looked to as an important method for improving patient care. Despite the availability of trainings for various QI methodologies, there are still many pitfalls along the road to change management, and it is important to understand the landscape. A critical component of success is the ability to utilize soft skills as well as technical expertise.
In our presentation at the Alliance meeting, we discussed the practicalities of implementing QI projects in the clinical setting. In systems with a mature Lean deployment, it is easier to implement changes because the frontline staff is empowered to make the necessary accommodations, and they have the support of leadership within the organization. However, most of us work in a more traditional organizational setting, where the people on the frontline take direction from those at the top. And the folks in the C-suite usually don’t completely understand the impact their bidding has on everyday operations. Coming in to this somewhat more conventional—and often hostile—environment to implement QI can have its pitfalls. The project we describe below was implemented in the latter environment.
Our presentation focused on three challenges that we experienced while attempting to implement a pilot QI project in a busy clinical setting:
- No administrative champion
- Lack of goal alignment
- Overstressed employees and/or those who no longer enjoyed their work
In this article, we will focus on No. 2, lack of goal alignment.
The symptoms of a lack of goal alignment manifest in a number of ways. Your needs might compete with someone else’s; stakeholders might not appreciate how your project could help achieve their goals; your goal might accidently expose the organization to a compliance risk. There are different ways to deal with each of these issues.
The QI project we highlighted involved the implementation of primary care group visits for patients with chronic pain. As this project had a significant impact on already slim resources, we needed to quickly facilitate goal alignment. In pursuit of this goal, we reserved a large room for half a day three times each month for the entire year. This wasn’t without challenges as the only available space to deploy the group visit was in a conference room two floors away and under the control of nonparticipating specialty practices who didn’t appreciate space in a non-patient care area being used clinically. The distant location also meant pulling the staff away from their practice location for two hours, three times each month. These competing needs created a tug of war that lasted throughout the 12-month project.
We initially received a green light from the participating clinic’s leadership for the project, but when they better understood the consequent impact these visits would have on typical clinic operations, their continued participation became reluctant. Their overarching goal was for clinics to run smoothly and safely within the already established operational model. Our goal of integrating an innovative care prototype that targeted an especially difficult group of patients didn’t appear to them to align with their goal.
Once they realized all the positive outcomes the project would bring to the clinic and the practices, it was easier for them to team with us on this QI implementation and turn their reluctance into enthusiasm.
Another challenge of using this conference room was its location away from typical patient care areas. Outfitting the room to meet the standards of a patient encounter location required special equipment to be brought in for each session as well as a special setup. Delivery, setup and pickup times often conflicted with other duties for the personnel who were responsible for activities in support of patient throughput. We again had to use our people skills to make ours the “task of choice” for these workers. Our goals were in direct conflict with theirs, and we were only able to get what was needed through respect, patience and excellent communication.
Sometimes innovative ideas can lead to risk of policy violations. One element of our project dealt with choosing an anti-inflammatory diet to manage chronic pain. Therefore, we wanted to provide healthy snacks high in fruits, vegetables and protein rather than carbs and sugar. In addition, we had planned to provide a “healthy cooking” demonstration. However, we discovered that cooking outside the food service area was a fire code violation. Furthermore, all snacks had to be individual servings. Nothing could be served if it wasn’t packaged by a licensed food handling professional. We had to get creative, but, we were able to locate some suitable options. We had failed to consider regulatory compliance when we originally planned our project, but those people who ultimately would have been impacted by any noncompliance made sure we were abiding by all regulations by the time we were underway. This allowed our project goals and the participating organization’s regulatory goals to stay in alignment.
By making sure we were good guests in our project sites and actively managing the needs of those around us, we able to successfully complete our project. Even better, because we were able to help the clinic leadership achieve their own goals, we were invited back to help plan how to best continue the group visit model after our project was completed. The elements that made us successful apply equally well to the more traditional efforts of CPD, showing that CPD is primed and ready to sit at the table with QI experts to help the healthcare industry improve the delivery of patient care.
- Price D. Continuing medical education, quality improvement, and organizational change: implications of recent theories for twenty-first-century CME. Medical Teacher 2005;27(3):259-68.
Points for Practice:
- Understand your stakeholders’ priorities, and be prepared to flex and compromise.
- Add value with your project, and communicate that value to leadership.
- Be aware of “spectator” stakeholders, and manage them as needed.
- Run your ideas by those who will be held accountable if a rule is broken.
The Importance of ‘WIIFMs’
We needed to help clinic leadership see the WIIFMs—What’s In It For Me?—and to realize the project’s successful outcomes would help them achieve their own goals of
- Improved care delivery
- High patient satisfaction
- A potential reduction in the use of opioids by study patients, a national goal and timely issue