Students gather by their posters at the IHI National Forum.
Every year, the IHI Open School receives hundreds of posters from students who have led quality improvement work, community organizing projects, and IHI Open School Chapters. At the most recent IHI National Forum, we selected four outstanding projects to feature in a special session. Get inspired as you learn how these students made a difference in their communities, and be sure to click the project titles to see the students’ storyboards to get an in-depth look at their work!
Creating a Pathway for Learners to Apply Improvement Skills on Health Justice in Our Community (IHI Open School Chapter Project)
Portland, Oregon, United States
Kanwar Thind, MPH, medical student and Chapter Leader, OHSU School of Medicine
Laken Harrel, MPH candidate and Chapter Leader, OHSU & PSU School of Public Health
Background: The PSU & OHSU Chapter of the IHI Open School is an interdisciplinary organization of students and faculty from Portland State University (PSU), Oregon Health & Science University (OHSU), and the OHSU-PSU School of Public Health. We aim to provide opportunities to practice community organizing and improvement methods on the front lines of health care. The group has developed a program to teach continual improvement with a focus on health justice, leadership, and quality improvement.
Aim: Through eight monthly sessions, the Chapter will provide 40 learners in the Scholars of Improvement Program a pathway to learn about and practice continual improvement through networking, the community health project, and guest speakers.
Outcomes: So far, the program has hosted two sessions, during which the learners selected community health projects focused on houselessness that they’ll tackle over the next six sessions. The Chapter also gained commitments from 35 people to attend at least six of the eight sessions to earn a Scholars of Improvement Certificate.
Reflections: We have found this experience to be both incredibly daunting and rewarding. In starting this program, we wanted to provide people a space not only explore frameworks for leading change, but also to generate excitement about the immediate opportunities to engage with the Chapter and make lasting improvements. Seeing what learners can accomplish in our Chapter in addition to the challenges of studies, jobs, and families has inspired us to stay engaged in our program and continue to grow Chapter membership. The most important thing we have learned is staying passionate about improvement. By focusing on the simple message of making things better, we have connected with learners from a wide variety of disciplines.
Improving imaging pathways for NICE CT Head Injury Guidelines (Quality Improvement Project)
London, England, United Kingdom
Elizabeth Vincent, medical student, King’s College London
Background: In the UK, over one million people visit the hospital each year with head injuries. A proportion of these patients are at risk of traumatic brain injury and long-term complications. The National Institute for Health and Care Excellence (NICE), a public body that provides national guidance, developed guidelines that identify risk factors and symptoms to help medical professionals decide whether and when a computerized tomography (CT) scan is indicated. In April 2017, delays in the CT head injury pathway contributed to a serious incident. As a result, my colleagues and I launched a team alongside an interprofessional group of health care workers to review the current system and implement effective changes to improve patient safety.
Aim: We sought to create and implement a series of interventions to increase compliance with NICE CT head injury guidelines to 95 percent or higher across the hospital over a 44-week period.
Outcomes: We reviewed 7,419 scans for compliance. Before our interventions, we found a compliance rate of 84.52 percent. Following our first, second, and third Plan-Do-Study-Act (PDSA) cycles, the rate rose to 87.82 percent (p>0.05), 88.11 percent (p<0.05), and 92.06 percent (p<0.001) respectively. Overall, compliance rose by 7.54 percent from the baseline. These compliance rates were sustained over four months following the third PDSA cycle, indicating that our project was successful in creating sustainable change.
Reflections: From this project, we learned how important a strong team is for success. Our team consisted of a mix of students, clinical staff, and senior management; each group had a critical role to play as the project progressed. It was incredible to see the value of clinician buy-in and the crucial role of champions at clinical, executive and managerial levels in change implementation, and long-term maintenance of change. As students, it is easy to feel that we are not experienced enough to make a difference during our clinical placements, but the truth is we offer a unique perspective. This experience has shown me that regardless of our experience level, we can all be agents for change!
Restructuring an IHI Open School Chapter to Support Greater Member Engagement (Community Organizing Project)
Boston, Massachusetts, United States
Alexa McWhinnie, RN, BSN student, MGH Institute of Health Professions
Katherine Cox, MS-SLP candidate and Chapter Leader, MGH Institute of Health Professions
Marykate O’Malley, ABSN candidate and Chapter Leader, MGH Institute of Health Professions
Background: The MGH Institute of Health Professions (IHP) Chapter of the IHI Open School seeks to involve students of all disciplines by promoting student-led conversation on health care improvement and establishing a strong presence within the IHP community. The Chapter board members took the IHI online course “Leadership & Organizing for Change,” which teaches the fundamentals of community organizing and relational strategies for change, as a development opportunity in the spring of 2018 and used the lessons learned to restructure their leadership model and establish opportunities for Chapter members.
Aim: We aimed to increase membership and overall awareness of the IHI Open School on campus. We also aimed to improve the leadership structure to promote Chapter sustainability, efficiency, and effectiveness.
Outcomes: The Chapter introduced a new leadership model, based on the snowflake structure described in “Leadership & Organizing for Change,” to better distribute leadership responsibilities across the Chapter’s board. Furthermore, leaders analyzed students’ awareness of the IHI Open School using a Community Assessment survey. We plan to use the results to catalyze increased engagement and to host data-driven community events.
Reflections: As we worked to better grow and restructure our Chapter, our team has learned just how critical the skill of active listening can be. IHP’s greatest strength is the interdisciplinary nature of the school. This strength is also our Chapter’s greatest barrier to achieving a consistent and representative leadership board, as every specialty program runs on a different cycle. Of the members that took Leadership and Organizing for Change this past academic year, only one is still an active student. As a result, the new leaders made it a point to sit down with former members to learn from their experiences. The new Chapter framework is a product of active listening and builds upon the knowledge of prior leaders rather than reinventing the wheel. In the spirit of quality improvement, it is something that we are not only proud of, but that we hope future leaders will continue to build upon when we leave.
Understanding Physician Opioid Prescription Practices for the Improved Implementation of Newly Developed EMR Tools (IHI Open School Recover Hope Campaign Project)
Dallas, Texas, United States
Sonal Gagrani, medical student and Chapter Leader, University of Texas Southwestern
Background: In 2016, over 42,000 deaths in America were caused by opioid overdose. In 2015, the Texas Medical Board changed their policy regarding chronic pain treatment from suggested guidelines to strict rules to enhance adherence. Students at the UT Southwestern Medical Center completed preliminary studies that indicated low physician adherence to several of the new rules.
Aim: As part of the IHI Open School's Recover Hope campaign, our team aims to increase the number of physicians adhering to Texas Medical Board Rule 170.3 regarding chronic treatment requirements to 100 percent by December 2019. More specifically, the team wants to understand current physician practices so that they can better guide implementation strategies for an opioid navigator tool built into the electronic medical record (EMR).
Outcomes: We identified the most common barriers to policy adherence as time constraints, low clinical value for some patients, and ease of access. The team is considering integrating data from the Prescription Monitoring Program, which tracks dispensation of these medications, into the EMR to move towards standardized institutional policy. Lastly, EMR tools are in place to improve ease of access for physicians, and physician education on these tools is currently underway.
Reflections: A highlight of this project was presenting the work to the opioid task force that exists at our school and seeing that they valued it and re-considered some of the existing decisions that had been made based on the new data. It can be difficult as a medical student to integrate into a group of administrators and physicians who are focused on solving big-ticket issues at the hospital, but by approaching the group with respect and enthusiasm, we can find ways to inform and expand existing projects or even create new ones.
Want to partner with student groups like this? Visit the IHI Open School Chapter Map, to see if there is an enthusiastic group of student leaders near you!