Why did you participate in the IHI Improvement Scholars Program, offered in collaboration with AIAMC?
The program was recommended to me by one of my mentors. I've always had a “bend,” if you will, for quality improvement. My father was a health care administrator and when the Institute of Medicine report,
To Err Is Human, came out, he put it on my desk and said, “You need to read this.” I probably rolled my eyes at him – I was in college at the time.
During medical school at Jefferson Medical College, I was part of the American Medical Association and that is where I learned about Lucian Leape’s article,
Error in Medicine. I read it and, since then, I’ve probably read it a dozen times. It remains an inspiring article. Also, as the ACGME [Accreditation Council for Graduate Medical Education] Clinical Learning Environment Review program has launched, I recognize that we have a lot to do as clinicians to get our educators up to speed. Since I’m an educator, I wanted to expand my skill set and learn quality improvement to be able to teach it to the next generation.
Describe your experience as an IHI Improvement Scholar is one word.
Transformative.
Okay, now tell me more. A year before I was a scholar, I picked up
The Improvement Guide and started taking the
IHI Open School courses to try to teach myself. I started to work through it on my own, applying some of what I was learning with the residents I teach because we were doing QI projects. And it was going alright. But the skillset you gain in the Improvement Scholars Program, and the opportunity to get indoctrinated in the culture of IHI, is phenomenal. The time I spent at IHI in Cambridge [Massachusetts] as part of the program was almost overwhelming because I was learning so much, but wanted to learn so much more. I could see the depth and breadth of IHI’s knowledge.
How have you applied what you learned in the scholars program?
The first thing I did when I went back to my organization was completely revamp the quality improvement curriculum to follow what I learned as a scholar. I had several residents join me on my project and three other resident teams started working on projects on topics of interest to them.
What did you choose to work on as your project during the scholars program?
The aim of my project was to decrease mortality from severe sepsis and septic shock. My institution identified sepsis as a high-value topic, and it was my assigned project as I became a scholar. We wanted to get ahead on sepsis, in part because the quality metrics were coming down the pipeline. We used the Model for Improvement and identified our primary and secondary drivers and started to chip away at them one by one.
How did it go?
It is definitely tough to influence an entire institution from one department. Our biggest challenge has been finding champions in other departments. We've been able to see some pretty decent improvements in all of our outcome metrics, and we identified various barriers that have made us scratch our heads. For example, patients who end up in palliative care — are they included in the data set? Not included? It was great to meet with people at the IHI National Forum [in December 2014] to see what they did with these challenges. Some institutions included these patients in their data set and their mortality looked similar to ours. Others didn’t and their mortality looked much better than ours. What you measure matters.
Looking back at what you learned, what reflections would you share with others?
The importance of the work. When I was at IHI, I had the opportunity to talk to the HR leadership about how they measure the happiness of the organization. That’s a big challenge in health care. Focusing on QI methods allows us to reverse some of the burn out and frustration, because we can begin to identify and solve problems ourselves. Building QI capability is extremely important for any educational leader and organization leader of hospitals and health systems.
