Why It Matters
New graduates of the Especialista em Melhoria program are at the forefront of a health care quality improvement movement in Brazil.
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Creating an Improvement Movement, One Expert at a Time

By Santiago Narino | Tuesday, October 3, 2017
Creating an Improvement Movement in Brazil, One Expert at a Time

Thirty Brazilian health care professionals joined the ever-growing worldwide network of improvement science experts when they celebrated their completion of the new IHI Improvement Specialist program in August 2017. They were the first graduates of the course, known as Especialista em Melhoria in Portuguese-speaking countries.

The 10-month Improvement Specialist program (known as Experto en Mejora Continua de Calidad in Spanish-speaking countries) is an exciting part of IHI’s global approach to building improvement capability. Improvement pioneers from across the country’s private and public health care sectors participated in the first wave of the Brazilian edition of the program, which held its three learning sessions in Sao Paulo. During the 3rd Latin American Forum on Quality and Safety, IHI had the opportunity to interview four participants to hear about their experiences and learn where their success will take them.

Paula Tuma – Medical Infectologist at the Hospital Estadual de Transplantes Euryclides de Jesus Zerbini

Over the last five years, many of Brazil’s health care systems have turned away from an exclusive focus on accreditation. Instead, many are embracing continuous improvement methods and collaborative measurement. People like Dr. Paula Tuma, infectious disease specialist doctor at the Hospital Estadual de Transplantes Euryclides de Jesus Zerbini, is propelling this important cultural shift. Her quality improvement journey started six years ago with her work managing adverse events in her hospital.

Reflecting on how she felt before her year of intensive training, Tuma says, “I felt something was missing, I didn’t have the right tools to do my job.” Paula describes her participation in the Especialista em Melhoria course as a transformative experience. It helped her understand why measurement is crucial for improvement and taught her the importance of patience and resilience. Her project focused on reducing central line-associated bloodstream infections (CLABSI). Over the course of the project, the Onco-Hematology Unit saw a 70 percent reduction, from 5.7 to 1.7 infections per 1000 catheter days.

Andrea Gushken — Pediatrician and allergist, project coordinator for improvement projects at Unimed Guarulhos and HCor- Hospital do Coração

Before the improvement movement started to gain momentum in Brazil, Dr. Andrea Gushken felt that those around her weren’t completely convinced of the importance of addressing quality. For Gushken, the Especialista em Melhoria course helped her use the science of improvement to bring together and engage her team, especially as they saw the results of using QI methods. Her project on redesigning patient flow focused on reducing wait times in the emergency room. It resulted in a 23 percent reduction, from 43.2 minutes in October 2016 (median for 10 months) to 33 minutes in June 2017 (median for 8 months).

Marco Cunha — Medical Director at Instituto de Responsabilidade Social Sírio Libanês

Before Dr. Marco Cunha took part in the Especialista em Melhoria course, his former organization (Hospital Estadual de Diadema – SPDM) didn’t routinely collect results after every improvement project. “While there were always a lot of changes,” Cunha reflected, “few were measured to ensure that they had results.” Now, a culture of measurement is developing as QI is gaining credibility. Cunha’s project on surgical wait times for elderly patients with hip trauma resulted in a drastic reduction from the average of 13.9 days to 4 days.

Maria Magalhães —Quality Director at Associação Paulista de Desenvolvimento de Medicina

As quality director of multiple hospitals in the state of Sao Paulo, Dr. Maria Magalhães had trouble understanding why individuals made medical errors. “I began to see that completely competent people made mistakes,” she recalls. The Especialista em Melhoria course has helped her understand adverse events from a systems perspective and how small tests of change can bring forth improvement.

Culture change starts with individuals who want to make a difference. The first wave of the Especialista em Melhoria program capitalizes on the idea that a critical mass of such people — trained in improvement science — is necessary to transform complex health care systems around the world. It is evident when talking to the first graduates of the course that their commitment and skills will help them be improvement pioneers for years to come.

Santiago Narino is project coordinator for IHI's Latin America team.

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