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"Everything in life can be good and bad. [The pandemic] brought us many opportunities to change a failed system.”
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Adapting Improvement Science in Crisis

By Tayna Brito | Tuesday, April 13, 2021
Adapting Improvement Science in Crisis Photo by Suzanne D. Williams | Unsplash

Though COVID-19 has led to much suffering and loss, it’s been encouraging to hear from health care professionals from around the world who report that they have also experienced positive moments in the past year. Notably, some teams report using improvement skills to make a difference for patients and families. For example, three hospitals participating in the Abraco de Mae (“A Mother’s Hug”) collaborative to reduce maternal mortality in Brazil report that they overcame some of the adversity brought by the pandemic by adapting and redesigning processes.

Nurses from three hospitals — Hospital Municipal Vila Santa Catarina, in São Paulo, capital of São Paulo state; Hospital São Camilo Cura d'Ars, in Fortaleza, Ceará; and Hospital de Clínicas de Uberlândia, in Uberlândia, Minas Gerais — shared some of the lessons they learned in the last year.

  • Test small changes to take on big challenges. All three organizations identified Plan-Do-Study-Act (PDSA) Cycles as the method most essential to their success. Erika Brosco Lima of Hospital Municipal Vila Santa Catarina reported that her organization used what IHI taught her team about simulation to test various ways to handle incoming COVID-19 patients. “We ran PDSA cycles to design our COVID flow,” she said. “During our simulation, we found several flaws. Today, we have a separate flow for COVID-19 patients who have respiratory issues and those that do not.” Angela Maria Machado of Hospital de Clínicas de Uberlândia said, “It was through testing and running the PDSAs that we were able to see where we could improve and get better results.”
  • Understand your processes. All three organizations also agreed about the importance of using flowcharts to draw a picture of how their pre-COVID processes worked to develop ideas about how to adapt to the coronavirus. The team at Hospital São Camilo Cura d'Ars used flowcharts to adjust how maternity patients flowed through their hospital. By doing this, they were able to isolate COVID-positive (or suspected) cases while following recommendations for promoting skin-to-skin contact and breastfeeding. Said Izabela de Souza Martins, “Our multidisciplinary team overcame barriers and challenges due to the pandemic, managing to adapt good childbirth practices.”
  • Keep things in perspective and celebrate your wins. Looking back on their challenging year, nurses from all three hospitals agreed that they were gratified by their teams’ ceaseless efforts to adapt to a new era. Lima said she was proud of “seeing our team overcoming fear.” When the pandemic first began, staff members were understandably apprehensive. “Today, we all feel secure and united. This feels like a victory,” Martins said. Machado of Hospital de Clínicas de Uberlândia in Uberlândia said, “Everything in life can be good and bad. [The pandemic] brought us many opportunities to change a failed system.”

Instead of putting quality improvement work aside when COVID-19 came to their doors, teams in Brazil used what they had learned about improvement science to face this new crisis. They adapted and readapted as they conducted PDSAs and mapped their processes on flowcharts. In the end, their teams’ skill and diligence helped them achieve success, and build confidence to face future challenges.

Tayna Brito, APM, is an Institute for Healthcare project coordinator.

You may also be interested in:

Quality Improvement Essentials Toolkit

The Power of Applying Improvement Science to the COVID-19 Response

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