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Applying Quality Improvement methods effectively helps us make sure that our patients get the right care by the appropriate person every time in a timely fashion.
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Putting the Lessons of the Improvement Advisor Program into Action

By Michael Posencheg | Monday, June 23, 2014

Mike Posencheg, MD, is the medical director of the intensive care nursery and newborn nursery at the Hospital of the University of Pennsylvania. He completed the IHI Improvement Advisor Professional Development Program in 2012.


Nine years ago, as a young faculty member in a busy academic institution, there were many patients to take care of and I was eager to make a difference in their lives. After finishing my fellowship in Neonatology at the University of Pennsylvania and Children’s Hospital of Philadelphia, I spent the first few years gaining clinical experience and determining my academic career path. Quickly, I learned that improving the care that babies received in our Intensive Care Nursery (not merely taking care of them) was my calling. I could do my best to provide the highest quality of care for our patients, but was this enough? The babies experience a system of care that involves so much more than just the efforts of any individual doctor or nurse. How do we make sure that our patients get the right care by the appropriate person every time in a timely fashion?  

For example, my team at the Hospital of the University of Pennsylvania observed that nearly half of the premature infants admitted to our nursery were hypothermic. This one factor — their temperature upon admission to the unit — is associated with an increased risk of morbidity and mortality when it is too low. I know keeping babies warm is important and can do my best to achieve that, but it is the system and processes of care the baby experiences in the delivery room and when transitioning to the unit that determines their admission temperature. 

There is a vast amount of research published every year evaluating procedures and treatments for neonatal conditions like maintaining normothermia. However, it is clear that there is a significant delay in getting that information to the bedside caregivers to improve patient outcomes. There are also many other aspects of patient care that do not have adequate evidence to guide therapy, but nonetheless require process improvement so that care is delivered consistently and in the appropriate way.

We decided to address these process of care issues at our hospital. This coincided with my decision to deepen my knowledge about improvement methodology. I took one master’s level class and sought out hospital colleagues with quality improvement skills to ask for their mentorship. Eventually, I determined that if I was going to be an effective leader responsible for improving patient care, I needed a more formal and complete set of tools. 

For me, the IHI Improvement Advisor (IA) Professional Development Program has been perfectly designed to address the kinds of problems I was seeing in health care. Designing and executing a QI project as part of the program was a fantastic, hands-on way to learn the most useful QI tools such as the Model for Improvement, team dynamics, use of run and Shewhart charts, and planned experimentation. The program is designed so that participants use these tools in a real (not merely theoretical) project to put the learning into practice.

I’ve also had an opportunity to develop my skills in teaching QI techniques by participating in IHI’s Improvement Advisor Graduate Program, which enables an IA graduate to go through an additional 10 months of training as a “teaching assistant” or “novice faculty.” This additional training has reinforced many key concepts and given me supervised experiences in teaching others how to use the Model for Improvement.

What difference has it made to develop an increased understanding of QI methodology? Prior to my attending the IA course, our hospital improvement team implemented some changes and the data showed some preliminary improvement in the babies’ admission temperatures. Now, the babies in our care have been normothermic at admission over 95% of the time for nearly a year! With my IA training I believe I was better able to coach the team, which now has a greater appreciation for the system of care and has been motivated by the improvements demonstrated by our data. I have seen substantial improvement in the quality of all of the projects we are running in the Intensive Care Nursery. The IA program has been the key to this. 

On a personal level, I take satisfaction in knowing that I am now seen as a leader in QI in my health system and I am frequently asked to help other teams address their improvement challenges. My proudest moment since completing the IA program, however, didn’t happen at my hospital, but at our national pediatric meeting a few months ago. I was discussing an abstract with another poster presenter, whose project was closely related to our neonatal admission temperature work. When I asked her about her control chart and shared some feedback I received about control charts for our project, she said, “Was that your paper in Pediatrics? We have been using that as a model for our project.” (We had published our results in Pediatrics in October 2013.) I walked away at the end of that discussion with a smile on my face and an appreciation that we were starting to make a difference.

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