How can I improve a process or make changes to the current system?
You will be improving your own processes of care constantly as you try different approaches and techniques in your area of expertise. You can use these same skills to improve the systems of care in which you work.
One great way to learn about improvement is to join an established team that is engaged in improving clinical care in an area in which you are interested. The team will have set an aim — a clear statement of what it wants to accomplish that is time-specific, measurable, and defines the specific population of patients that will be affected. Measures will have been developed to determine whether a change leads to an improvement, and the selection of changes to improve care will have been selected. The next step is to test a change in the real work setting. The Plan-Do-Study-Act (PDSA) cycle is shorthand for testing a change — by planning it, trying it, observing the results, and acting on what is learned. This is the scientific method, used for action-oriented learning.
You don’t have to be part of an established team to improve a process though. You can develop aims, measures, select changes, and run tests yourself. For example, you may find that clinicians often forget to check the feet of diabetics, an important health issue for people with this disease. You decide that you want to try and improve the rate of foot checks by 50% in one month. You read about advances in diabetic care and find that a simple change — having the person putting the patient in the exam room request that the patient remove their shoes and socks — serves as a visual cue for the examining clinician to check the patient’s feet, and the rate of foot checks improves. You decide to run a test of this change yourself with the next diabetic patient.
Related Courses/Lessons
QI 102: The Model for Improvement: Your Engine for Change
QI 103: Measurement for Improvement
April 27, 2009: David B. Nash, MD, MBA, Founding Dean, Jefferson School of Population Health, Thomas Jefferson University - Interested in having quality improvement and patient safety in the curriculum at your school? Wish you knew how you could help make it happen? Listen in.
August 6, 2008: Carol Haraden, PhD, Vice President, Institute for Healthcare Improvement - Have you ever been spared a dead car battery by a beeping noise that reminded you to turn your car lights off? A nurse administers a wrong dose because medication labels look similar. A doctor is interrupted by a page and then gives the nurse incomplete patient orders...
May 15, 2009: Parker Palmer, sociologist, Paul Batalden, Dartmouth Medical School professor, David Leach, former CEO of the Accreditation Council for Graduate Medical Education - When you spot a patient who’s not getting the best possible care, what do you do? How do you speak up? Join the discussion.
What can we learn from a successful improvement project in rural Rwanda? Discussion questions included.
Patients aren’t showing up for their appointments at the community health center. The results? Delays, overcrowding, and mounting frustration for everyone. Can this clinic be saved?
A young woman's lupus flares up, along with a complicating infection. Her providers struggle to coordinate care as her condition deteriorates.
Noah Zanville, a student at Indiana University School of Nursing, shares his experience at the 20th Annual National Forum on Quality Improvement in Healthcare in Nashville, TN and explains why other students should consider attending in the future.
“By and large, hospitals that want to educate health professionals about quality, safety, and teamwork have to start from scratch with each new graduate they hire,” says Linda Cronenwett, PhD, RN, FAAN, Dean and Professor at the University of North Carolina, Chapel Hill School of Nursing (Chapel Hill, North Carolina, USA). She is involved in a national initiative to change that reality.
In 2004 Dr. Brian Koll was searching for a method to speed culture change at his institution, Beth Israel Hospital in New York. This story profiles efforts at the hospital to introduce quality improvement to the next generation of health professionals.
Have you ever left the doctor’s office in a rush without asking all of the questions you had? This brief article summarizes a few organizations’ method of guiding patients through their care. The article also explains how this approach to care provides benefits to patients and health care organizations.
This article describes a study where 77 medical, physician assistant, nurse practitioner, and health services management students were provided training in quality improvement, community-oriented primary care, and teamwork. These students were then formed into 13 interdisciplinary teams to apply their knowledge in underserved areas ("service learning") under a community and faculty preceptor.
A group of health professions students from seven countries participated in the International Forum on Quality and Safety in Health Care, held April 2008 in Paris. Each day the students met to reflect on key topics discussed in the sessions they attended. This article provides a summary of some take-home lessons on topics such as improvement methodologies, effective teamwork and communication, and involving students early in quality improvement.
This article describes the influx of new energy and ideas that often accompany students who enter health care organizations. As these students learn quality improvement principles they can often greatly help organizations improve their quality.
This article describes an interdisciplinary course in continuous improvement developed by the Schools of Medicine and Nursing at Case Western Reserve University and the Program in Health Administration at Cleveland State University, which focuses on learning through experience. The course accommodates a large number of students, and has created new partnerships with Cleveland area health care organizations.
What makes a good health care leader? Does leading Quality Improvement activity require a specific skill set? This activity will help you identify some of the desirable characteristics of a leader and provide answers to some of these questions.
Often, clinicians develop health care delivery systems and procedures without taking into account the “voice of the patient.” The purpose of this exercise is to increase awareness of our health care experiences as patients, or as the family members or caregivers of patients.
In 2005, Mayo School of Graduate Medication Education implemented a program to train all its resident and fellows — more than 1,500 students on three campuses — in quality improvement and safety.
In April 2009, we asked students and faculty to explore their schools' curricula to find out whether quality improvement and patient safety are included -- and if so, where.
Watch Parker Palmer's "A Movement Model of Social Change" plenary speech at the 10th Annual National Forum on Quality Improvement in Health Care (December 1998).
Think you’re powerless because you’re a student? Think again. In this video, four students explain how they pursued real-life improvement projects – and turned their experience into presentations and publications.
[Presented at the 20th Annual IHI National Forum on Quality Improvement in Health Care, December 10, 2009.]
Our leaders look to us to spread the importance of changing the quality of care for our patients. On October 22nd, we held two national webcasts to discuss the first opportunity for all Chapters to unite for a common cause, help spread the WHO Safe Surgery Checklist, and work to implement, measure, or raise awareness of its use.
Not every program offers coursework in safety and improvement. But with a little effort, you can get the training you need. Nursing student Montana Schultz suggests a few ideas to get you started.
Achieving Competence Today (ACT) is a teaching resource for health care educators. ACT develops and provides resources for the ACGME Systems-Based Practice and Practice-Based Learning and Improvement, and for the AACN Essentials of Graduate Nursing Practice competencies. Educators have several options for finding and downloading high-quality curriculum materials.
