Suma Prakash, MD, MSc, FRCPC, a nephrologist at Temple University Health System, decided to help patients with late-stage chronic kidney disease with their decision-making. She wanted them to feel informed and empowered to choose the best option for themselves, plan for their care in advance, and avoid urgent dialysis in hospitals, if possible. Participating in IHI's Quality Improvement (QI) Practicum: Moving from Theory to Action Online Course with Coaching helped give Prakash the knowledge and time to bring her team together to improve education for their patients.
When she started the project, Prakash kept remembering her time doing traditional research. She soon realized that the standard scientific method was not the most effective approach to QI work. Instead of taking months to develop a perfect project, for example, with QI “you can go back [and] revisit the process,” Prakash explains. “That’s not wrong for QI.”
Prakash established baseline measures, including the percentage of patients attending the education classes. Working with their nurse practitioners (who taught the classes) and other colleagues, the team began testing.
As is often the case with improvement projects, the team struggled to prioritize their efforts because they did not have a lot of time to devote to it. However, the QI Practicum course helped motivate and hold themselves accountable. It also created a supportive community of peers among Practicum participants.
Over time, Prakash also found support from her colleagues. Seeing progress on the project brought more of them into the work. They shared ideas and problem solved.
As a multidisciplinary team, everyone on her team provided different perspectives. This led to a variety of testing ideas. For example, when reminder calls did not yield the hoped-for results, they went back to the drawing board and began testing sending letters that included information on the benefits of the education classes.
Though it is still early to see measurable results, there have already been improvements in their teamwork. For example, when someone could not make a project check-in, team members filled in for one another. Their confidence as improvers has also grown. They’re hopeful they will find solutions that they can scale up and sustain.
Even as their project continues to evolve, Prakash has advice for people beginning a QI initiative:
Just start. It will not be perfect, especially at first. It can’t be. But you can’t begin improving without starting somewhere.
Determine your measurement plan. Decide what to measure, how to measure it, and who is responsible for each component of work. Establishing baseline measures allows you to find the gaps in care and where to focus your efforts.
Do not try to go it alone. You never know who will be interested in joining your efforts. Prakash was surprised at how many people had a vested interest in helping improve education for patients with late-stage chronic kidney disease. Some were skeptical at first, but once they saw the baseline measures and tests taking place, they wanted to help.
Get QI experience
. If no one on your team has it, get it. Take a QI course (like those available from the IHI Open School
) or connect with someone with QI experience. When she got stuck or needed guidance, Prakash found it helpful to consult with the QI Practicum coaches. “I had this project idea for a while,” Prakash stated. “[The QI Practicum] gave me the tools and confidence to do it.”
Prakash knows her team’s work is just beginning. They continue to test, measure, and learn. They know they can keep coming together to try new ideas for improving patient experiences and outcomes.
Sara Kramer is an IHI Project Coordinator.
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Quality Improvement Essentials Toolkit
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