Photo by Thomas Kelley | Unsplash
While some organizations have paused health care improvement work during the last few months, one team has demonstrated the usefulness of applying improvement methods and skills to their hospital’s COVID-19 response. They participated in the Mexico in Alliance with St. Jude Golden Hour (MAS+) Collaborative and the Improvement Science in Action professional development program.
Griselda Escobedo Meléndez, MD, a pediatric infectious disease specialist from Hospital Civil de Guadalajara Dr. Juan I. Menchaca, in Jalisco, Mexico, has led one of the most impressive teams taking part in. This project is a joint effort between the St. Jude Global Mexico Regional Program and the Institute for Healthcare Improvement (IHI). The 18-month MAS+ Collaborative brings together 23 Mexican hospitals and over 150 health professionals with the aim of reducing treatment-related morbidity and mortality among children with cancer.
Over the last 12 months, Dr. Escobedo Meléndez and her team have worked to reduce the time between when a febrile child with cancer is first assessed in the emergency department and when they receive the first dose of antibiotics to equal or less than 60 minutes, with the goal of reducing infection-related mortality in this patient population. Currently on track to surpass this goal, the team credits the formation and camaraderie of the team as the keys to their success. Using improvement tools like driver diagrams and process mapping to co-design their work allowed multiple voices to contribute to their progress.
Throughout the project and the development of their team, they recognized the importance of activating everyone’s agency. As described in IHI’s Psychology of Change Framework, agency is “the ability of an individual or group to choose to act with purpose.” When noting resistance to change, Dr. Escobedo Meléndez reviewed what she had learned about the three changes in mindset needed when building improvement. Instead of telling her team members what to do, she focused on what they wanted to do, where their values and assets aligned with the organization, and how they were “all in this together.”
Dr. Escobedo Meléndez also created a psychologically safe environment in which her team could openly express disagreements and doubts. When dealing with conflict, she led with curiosity. She encouraged collaboration, dialogue, and integration of new thinking from those who were initially reluctant to change.
The team has worked hard to adapt to changes brought by the COVID-19 pandemic, including the increase in morbidity and mortality among the general population and health care providers. What they learned from their improvement project about how to best implement rapid changes has been especially useful in dealing with the pandemic. For example, they created a driver diagram to improve the care for pediatric cancer patients during the COVID-19 pandemic, with change ideas focused on limiting exposure to the virus and education for parents and children on prevention strategies. What they learned in the last year about process improvement, improving communication with parents (so they could be part of their children’s care), running Plan-Do-Study-Act (PDSA) cycles, and testing at small scale has proven to be especially useful in times of stress and high uncertainty.
Communication, co-design, and building improvement projects centered around patients and families can be difficult. These challenges have increased during the current pandemic, but the team at Hospital Civil de Guadalajara Dr. Juan I. Menchaca has demonstrated the benefits of being people-centered yet methodical. They’ve learned — despite the urgent demands of dealing with COVID-19 — that slowing down, building a team, testing and continuously adapting processes, and using improvement and psychology of change tools can be useful in times of crisis.
Santiago Nariño is an IHI Project Manager.
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