"Keyboard Contradiction" by MacBeales is licensed under CC BY-ND 2.0

Some health care organizations may be wrestling with the idea of pausing their quality improvement (QI) efforts while they deal with the COVID-19 pandemic.

Chief Scientific Officer Emeritus and IHI Senior Fellow Don Goldmann cautioned against making what he sees as a false choice.

During the IHI Virtual Learning Hour on April 24 (Quality Improvement, Epidemiology, and COVID-19), Goldmann described how the health care institutions doing the best job of handling COVID-19 use epidemiology alongside quality improvement principles, methods, and tools, including:

• Agile, real-time testing
• Using systems thinking and learning
• The use of visual management boards, huddles, SBARs, and other improvement tools
• Prioritizing both patient and workforce safety

“You don't have to use QI terminology,” he noted, to appreciate the importance of building and using improvement skills before, during, and after a crisis.

During the hour-long program, Goldmann also proposed using tools like Failure Modes and Effects Analysis (FMEA) Modes and Effects Analysis (FMEA) as organizations and communities contemplate how and when to reopen. He described FMEA as a proactive method for evaluating a system by determining where it can fail, how to detect failure, how to mitigate failures, and identifying the possible consequences.

Goldmann described the need for leaders to not only use the COVID-19 data to make decisions about reopening a community or workplace, but also to “get in touch with the reality of the people who have to go back to work.” He suggested using FMEA to think through what reopening will mean for employees, taking into consideration, for example, “where and how they live, how they commute, what are the consequences for their family” if they become ill. Leaders, Goldmann noted, need to balance the real economic stress and suffering caused by closures against the risks people face of coronavirus exposure or the risks they may pose to others.

To learn more about the crossover between epidemiology and health systems improvement, watch and listen to the full Virtual Learning Hour. Learn more about future episodes in IHI’s special series of weekly COVID-19 Virtual Learning Hours.

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