Improving Quality Improvement: Optimizing Collaboration Between Stakeholders
Track: Full Session
Health care does not happen in a vacuum—rather, it requires a team. Quality health care requires that members of that team collaborate effectively. Such collaboration can be difficult to achieve, especially when the team comprises disparate stakeholders, each with related but different goals and interests. It seems obvious and, in fact, research tells us, that effective collaboration depends on communication and that some types of communication are more effective than are others.
Quality improvement (QI) in healthcare systems is most effective when the relevance and value of each identified knowledge and/or practice gap is understood from the point of view of all of the involved professional and specialty stakeholder groups. Such understanding optimizes development of QI that leads to appropriately targeted systems modifications and educational interventions that, in turn, lead to the fast and accurate passage of a patient through the complex steps leading to diagnosis and optimum treatment.
All too often, however, healthcare QI interventions fall short of intended results, negatively affecting costs and worker satisfaction without improving patient outcomes.1 This may result from the mistaken assumption that interventions are transferrable from one stakeholder context to another without modification2 and/or difficulties in separating intervention effects from the context in which they were introduced.3 We suggest that nominal group technique (NGT) can play an important role in successful implementation of healthcare QI interventions by optimizing collaboration to overcome the limitations introduced by stakeholder-specific contextual understandings. NGT effectively engages stakeholders, creating a shared understanding across multiple contexts; identifies root causes of a problem as well as knowledge/practice gaps as they relate to each stakeholder group; and provides information about the attitudes and perspectives of each stakeholder group to inform the structure and approach of education interventions and system modifications. In addition, NGT is effective in creating tension that can facilitate change4 and can help identify hidden norms that may affect implementation of written processes.
This session will involve presenters from both University of Alabama at Birmingham (UAB) and Medscape education and will describe the NGT process and share lessons learned, as well as best practices, through presentation of a case study in which NGT was used to inform and facilitate a QI collaboration between the UAB Healthcare System and the University of Alabama School of Medicine (UASOM) and which then informed collaboration with Medscape Education.
The case study examines UAB Hospital’s initiative to achieve certification as a comprehensive stroke care center and describes collaborations that led to the systemic changes and the education programs that aimed to reduce the time needed to recognize and appropriately treat patients with acute ischemic stroke (AIS). To optimize collaboration between the disparate stakeholders involved in diagnosis and care of patients with AIS, the UAB School of Medicine CME Division conducted NGT-based exploratory discussions with each of four stakeholder groups – emergency department (ED) physicians, ED nurses, neuro-radiologists and neurologists. Those discussions both increased “buy-in” to the QI efforts and produced an accurate and up-to-date understanding of current knowledge and treatment barriers, as viewed from the multiple points of view of the involved professions and specialists. That information, in turn, informed development of appropriate educational programs and materials. Taken together, these QI and QI education efforts contributed to attainment of the desired certification and significant improvements in knowledge and practice of healthcare providers involved in care of patients with AIS.
- Moraros J, Lemstra M, Nwankwo C. Lean interventions in healthcare: do they actually work? A systematic literature review. Int J Qual Health Care 2016;28:150–65.
- Dixon-Woods M, Bosk CL, Aveling EL, Goeschel CA, Pronovost PJ. Explaining Michigan: developing an ex post theory of a quality improvement program. Milbank Q 2011;89:167–205.
- Hawe P, Shiell A, Riley T. Theorising interventions as events in systems. Am J Community Psychol 2009;43:267–76
- Delbecq AL, Van de Ven AH, A Group Process Model for problem identification and program planning. The Journal of Applied Behavioral Science. Volume 7, Number 4, 1971.