Why It Matters
A Chapter from the University of Illinois at Chicago used quality improvement tools like root cause analysis to propose the winning case in the Clarion Case Competition.
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Working as a Team to Address Housing Insecurity and Homelessness

By IHI Open School | Monday, July 8, 2019

Members of the Univeristy of Illinois at Chicago Open School Chapter

The University of Illinois at Chicago (UIC) OS Chapter won the Clarion Case Competition, an interprofessional case competition hosted annually by the University of Minnesota. In this interview, Frank Borgers, Jennifer Neely, Martin Finnegan, and Crissel Marie Soriano Arban share the story of the initiative they designed to address housing insecurity and homelessness in their community.

Congratulations on your win at the Clarion Case Competition! Can you tell us about the initiative you designed?

This year’s case was a real-world issue. Over 300 individuals experiencing homelessness had established an encampment in south Minneapolis, and there were an increasing number of health care emergencies (including deaths) occurring in the camp. Our task was to come up with an innovative service or system-wide improvement to address both the housing insecurities and health care needs of this population.

The encampment was closed in December 2018 after community partners opened the Navigation Center, a temporary shelter that provides a safe and service-rich environment for the affected individuals. Although most members of the encampment have been temporarily housed at the Navigation Center, further efforts are needed to improve health outcomes and housing retention. Current homelessness prevention programs and services are difficult to navigate, and disjointed city and state efforts to end homelessness have lacked effective coordination and communication. This was a key factor that we considered when formulating the HOPE strategy: Health and Housing Options to Promote Empowerment. 

The first HOPE initiative is to implement an interprofessional Street Team that provides on-site medical care and recruits individuals experiencing homeless to become clients of the HOPE service providers. The second initiative is to establish a multidisciplinary Home Team that provides case management, service coordination, and integrated primary care. The third initiative is to develop partnerships with community stakeholders that provide supportive services and financial assistance. The implementation of the proposed HOPE strategy will allow Heading Home Hennepin (the local partner that we pitched our proposal to) to assist the county in achieving functional zero while providing care and services through trusted channels. The HOPE strategy strives to recruit, rehouse, and retain clients to ultimately create a sustainable program that empowers an underserved population.

What were the essential components of your success?

Critically, every member of the team was moved by this problem and motivated to put sincere effort into working on it. The team put a ton of effort into the preparatory research, diving deep into the issue and going well beyond the case materials themselves to really understand the unique patient population, local conditions, and stakeholders at play.

Additionally, we were extremely fortunate to have the opportunity to engage with some of our University’s community of professionals, some of whom have devoted their lives to this issue. We consulted closely with two amazing UIC resources: Dr. Stephen Brown, Director of Preventive Emergency Medicine at the Department of Emergency Medicine, University of Illinois Hospital and Health Sciences System and Joshua Smith, an MD / MPH student who helped found Chicago Street Medicine with the goal of improving the health of the city’s homeless through outreach, education, research and advocacy.

Our access to, and ability to draw on and integrate practical knowledge and wisdom from these experts, combined with our use of IHI resources and other research tools, allowed our team to develop thoughtful and feasible proposals for addressing the incredible complexity of this case.

Finally, we received tremendous support from our two Chapter faculty advisors, Dr. Borgers and Dr. Durham, whose investment, excitement and commitment went above and beyond what we expected.

The take-home message was something all of us, as champions of interprofessional work, already know, but it was rewarding to see it put into action: working in silos will not solve big problems—only broad, dedicated, equitable teams can even get close.

How did you leverage what you learned through the Open School courses and your Chapter throughout this process?

Dr. Borgers and Dr. Durham were very insistent that we apply the IHI principle of deep root cause analysis before even thinking about identifying solutions! We ended up using Open School materials on root cause analyses and actions to do this work. This methodical and deliberate approach was invaluable. It helped us target and identify the various factors that affect individuals experiencing homelessness and provided a strong methodology to analyze systemic problems and notice patterns that we could address through interventions. It also helped us craft our strategy because root cause analysis is about examining systems and looking beyond an individual decision or action that may be the end result of a more widespread problem. This is certainly true for the issue of homelessness, and the IHI Open School gave us the skills and orientation needed to assess the various systems involved in our case.

What key lessons would you share with other students launching quality improvement work in their communities?

Crissel Marie Soriano Arban: Remember the importance of interprofessional collaboration. Everybody has something to contribute within a team, and there are many opportunities out there to learn from one another. In regard to getting to the bottom of a problem through root cause analysis, continue to ask yourself “why.” Why is this still happening? Why has this not been fixed yet? In order to provide better health care, you must address all holes in the Swiss Cheese Model.

Martin Finnegan: If your Chapter is launching a QI project in your community, you will learn many lessons. Here is some advice from the lessons that I have learned with my Chapter:

  • Listen carefully to the voice of the consumer or patient, those who will be most affected by your work. Input from community members is essential because ultimately, the success and sustainability of a QI project will depend on buy-in from people living in the community.
  • Be willing to collaborate and contribute in any way you can. When you volunteer, know that the little things do make a difference!
  • Keep an open mind. The answers to difficult problems sometimes come from places you don’t expect.

Jennifer Neely: While being able to exercise critical thinking to identify gaps and root causes of the problem is a key component of this type of work, the most crucial element of QI projects is teamwork. Further, we shouldn’t be limited by our definition of team; this is where interprofessionalism comes into play. Recruit widely and solicit a diverse variety of knowledge, including those with firsthand experience, listen to the people you are trying to help, and listen to people who’ve had successes in this area. Be humble in your investigations, and you give yourselves a better chance to learn, and a better chance to hit on a workable improvement.

We were very lucky that our team was introduced to people who’ve worked in this area for a number of years: doctors who provide street medicine in our city, people with experience in public health and designing for health, heads of departments in medicine and health administration; I consider them unofficial members of our team.

Frank Borgers: I would share the energizing and motivating power of the UIC Open School model and the extraordinary things students can accomplish when provided excellent resources, a solid framework, and the freedom to work independently as a true interprofessional team (plus getting really lucky in finding such a great group of collaborative students)!

What’s next for your Chapter?

The continuation of our quality improvement projects is one of our primary goals. In one of our ongoing projects, we are using Plan-Do-Study-Act (PDSA) cycles to test patient education materials related to healthy living at a health center in the Humboldt Park neighborhood of Chicago. We have completed dozens of patient interviews to better understand how we can work with the clinic and develop culturally sensitive educational materials pertinent to their patients’ needs. In our first small test of change, we’ve addressed the top concern of patients based on the interviews – need for information on healthy lifestyles. We developed a video channel playing on a loop in the waiting room, using evidence-based resources on healthy lifestyles and provide recipes in English and Spanish that include our healthy “recipe of the month” and other tips for healthy eating. We hope to build upon our relationship with the health center, Mile Square Health Center – Humboldt Park, and sustain these improvements led by open school students to adopt new materials based on the survey priorities.

Some of our students are working with an interprofessional consulting team through the UIC College of Nursing to develop a comprehensive quality improvement plan for the department of corrections in Illinois. Students are learning about quality, safety, and performance measurement from experts in the field.

Our Chapter is also transitioning to a new leadership board. We held elections in April and will be looking to new student leaders to take the reins on our various projects, provide members with the future direction of our organization, and generate new opportunities within our Chapter. 

We will be working and pushing hard to leverage the gains, energy, and creativity of our Chapter to move and embed interprofessional collaborative education and practice across and within our health science colleges and our university’s amazing mission driven health system.

Editor's note: This interview has been edited for length and clarity.

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