Editor’s Note: Colleen McCormick, a fourth-year medical student from Wright State University in Ohio, is using the IHI Open School Quality Improvement Practicum to conduct her first quality improvement project.
Every Wednesday during February and March, Colleen will write a blog post about her progress as a student trying to make a change in the health care system. You can catch up on her previous posts here.
By Colleen McCormick, fourth-year medical student, Wright State University
Last week, I introduced our baseline data and described the PDSA cycles we hope to implement. As we wait for the “Do” and “Study” portions of the cycle to take place, I thought I might take some time to reflect on my experiences thus far with my quality improvement project. Since this is my first project, I’m really trying to make sure I catch every little piece of learning. To that end, here are five things I’ve learned so far:
1. Don’t start too big.
In my first post, I discussed a great dataset that Dr. W had requested. It had all of the CT scans performed in our Emergency Department for a one-year period — more than 9,000 scans! While a huge chart review might lend us information about trends in radiograph use, this type of study is not necessarily conducive to a quality improvement project. As I started going through the data, I realized that I would never have time to look through thousands of charts. In the end, narrowing the scope of this project helped us analyze the data much faster. Remember, a quality improvement project can start with just one patient. You can always scale up if a change is beneficial for patient care!
2. Don’t get discouraged if your project turns out to be a dead end.
Our first project’s aim was to reduce head CT scans for patients with headaches. As we started our analysis, we realized that the data didn’t lend itself to a quality improvement project. In fact, most of the CT scans ordered could be considered appropriate for patient care. We were glad that our radiologists and emergency room physicians were making appropriate decisions about radiation. However, this was also frustrating because we no longer had a QI project! Working with a mentor who practices QI on a regular basis was the perfect solution. Within 30 minutes of stopping our CT scan project, Dr. W had proposed three new improvement projects! That brings me to the next lesson learned …
3. Find a strong mentor.
Dr. W has been a great mentor for several reasons. First, she is the director of our hospital’s QI department. That means she is involved in multiple QI projects, and she has worked with most of the employees in the hospital to improve patient care. Her broad network has proved invaluable in development and implementation of my QI project. She is also very open to working with students. She is one of the faculty advisors of our IHI Open School chapter, and she has encouraged students to participate as little or as much as they want in her QI work. This makes it easy for us to learn QI while still fulfilling our curricular requirements as students!
4. Spend a lot of time developing a strong aim.
At the beginning of my project, I did not realize how much work and analysis it would take to write that single sentence! I imagined that I could sit down and come up with an aim based off our goals for the project. In reality, development of the aim took many steps. I needed to review the medical literature to learn what other institutions had accomplished in palliative care utilization. We had to meet with many health care professionals from both the ICU and palliative care settings to understand their expectations and goals for the improvement project. And we needed to analyze retrospective data to examine our baseline utilization of palliative care. All of these activities helped us create a strong and achievable aim statement.
5. Work with an interprofessional team.
I cannot emphasize enough the importance of working with a multidisciplinary team. During project No. 1 on CT scan utilization, the team consisted of just Dr. W and me. I had no context for the project, and no interactions with radiology or ED staff. I was basically an outsider trying to fix a problem I didn’t fully understand — a big faux pas in QI! Round 2 has been much more successful. Our team consists of nurses and physicians in both the ICU and palliative care setting; residents and another medical student; data specialists; and a QI expert (Dr. W). We can bounce ideas off each other, and compare our goals for the project and the planned interventions we want to make. While team meetings and multidisciplinary discussions were more time-intensive, I felt that we were able to gain stakeholder approval of the project before it even got off the ground. If you are going to lead a successful QI project, you must have the backing of those people most affected by your changes!
I hope these lessons can help you in your quality improvement endeavors!
Have you worked on a QI project? What would you add as tip No. 6?