How to get started in quality improvement: Best Practices

Quality improvement is a core component of many undergraduate and postgraduate curriculums. Numerous healthcare organisations, professional regulators, and policy makers recognise the benefits of training clinicians in quality improvement.

Engaging in quality improvement enables clinicians to acquire, assimilate, and apply important professional capabilities such as managing complexity and training in human factors. For clinical trainees, it is a chance to improve care; develop leadership, presentation, and time management skills to help their career development; and build relationships with colleagues in organisations that they have recently joined. For more experienced clinicians, it is an opportunity to address longstanding concerns about the way in which care processes and systems are delivered, and to strengthen their leadership for improvement skills.

The benefits to patients, clinicians, and healthcare providers of engaging in quality improvement are considerable, but there are many challenges involved in designing, delivering, and sustaining an improvement intervention. These range from persuading colleagues that there is a problem that needs to be tackled, through to keeping them engaged once the intervention is up and running as other clinical priorities compete for their attention. You are also likely to have competing priorities and will need support to make time for quality improvement. The organisational culture, such as the extent to which clinicians are able to question existing practice and try new ideas, also has an important bearing on the success of the intervention.

This article describes the skills, knowledge, and support needed to get started in quality improvement and deliver effective interventions.

Best Practices

• Recognize needed skills- Enthusiasm, optimism, curiosity, perseverance, relational skills, practical skills, managing complexity, time management, and enjoying the experience are all necessary to build quality improvement.  
• Build your team- The first step is to recruit your improvement team. You need a blend of skills and perspectives in your team. Find a colleague experienced in quality improvement who is willing to mentor or supervise you.
• Identify a problem- Next, identify a problem collaboratively with your team. Use data to help with this. Take time to understand the contextual factors and what might be causing the problem. 
• SMART framework- Next, develop your aim using the SMART framework: Specific (S), Measurable (M), Achievable (A), Realistic (R), and Timely (T). This allows you to assess the scale of the intervention and to pare it down if your original idea is too ambitious. Aligning your improvement aim with the priorities of the organisation where you work will help you to get management and executive support.
• Map stakeholders- Having done this, map those stakeholders who might be affected by your intervention and work out which ones you need to approach, and how to sell it to them.
• Find support- You need support from both your organisation and experienced colleagues to translate your skills into practice.

The full article can be downloaded below.  

Success At Cleveland Clinic And The Future Of Healthcare

Healthcare is being transformed with new alignments of medical personnel, digitalization and personalization, focus on prevention and internationalization, according to Cleveland Clinic CEO Tom Mihaljevic. Cleveland Clinic is leading the way in a number of these areas. I interviewed Tom on The CEO Show, and he outlined some of the key features that have earned top-ratings for Cleveland Clinic and his vision of the future of healthcare. 

Cleveland Clinic is an international healthcare provider employing 60,000 caregivers. The majority of its hospitals are around the City of Cleveland, Ohio, and they have hospitals in southeast Florida, Las Vegas, Toronto and Abu Dhabi in the United Arab Emirates. They are now building a hospital in London.

I asked Tom what sets Cleveland Cleveland apart as it earns its top ratings in clinical care and outcomes year after year.

“The most important differentiator for Cleveland Clinic, in our belief, is in our model of care. Cleveland Clinic is organized in such a way that we work as teams,” Mihaljevic said.

The full Forbes article can be viewed at this link.  

Digital Healthcare Growth Drivers In 2019

The digital transformation of healthcare will see significant growth in the next 12 months fueled by institutional interest in driving down costs and improving patient engagement. Expect increased pharma investment, improving regulatory status, payer engagement with digital tools and better telemedicine connectivity through consolidation.

Digital health will build on the major events of the past year. Amazon made headlines at the beginning of 2018 with its announcement of collaborating with Berkshire Hathaway and JP Morgan to create a new entity to improve care options for their employees. Towards the end of the year Amazon got attention again with its expansion into software to digitize and mine patient medical records to improve treatment and cut costs. It joins the ranks of IBM and UnitedHealthcare’s Optum, as well as Apple and Google’s efforts to mobilize, organize and analyze health records. The anticipated buyer for all these services are health systems that have historically lagged in fully embracing the potential of electronic record analytics.

The full Forbes article can be viewed at this link.  

Implementation of Patient Engagement in the Netherlands: A Stimulating Environment within a Large Academic Medical Centre- Best Practices

Patients are the official third party of the Dutch healthcare system, apart from healthcare providers and insurers.  Radboud university medical center (Radboudumc) is a regional centre for specialized secondary care in the Netherlands.  Here innovation is recognized as a decisive factor when it comes to the implementation of patient engagement.  Therefore, all employees are invited to innovate, experiment, fail and implement promising innovations into practice.  In this paper, we demonstrate how this stimulating environment led to a rich collection of patient engagement activities in organizational (re-)design and in educational programs for students and employees.

Best Practices

• Support experimentation - Support the non-homogeneous evolution of engagement in which employees are free and motivated to experiment.  Allow initiatives to fail.
• Involve patients - Build long-term relationships with patients by involving them from the beginning until the end.
• Create a comfortable environment that makes involvement meaningful - For patient engagement at the organizational design and governance levels, ensure that patients stay in their role of patient, guaranteeing that they make a unique and complementary contribution.  For patient engagement at the level of direct care, ensure that each patient is seen as a person, with a unique and complementary perspective on healthcare.
• Prepare and organize - Prepare patients for their efforts in patient engagement and organize patient engagement in a professional manner to ensure that it is valuable to the organization.

The full article can be downloaded below.  

Choosing Wisely campaigns globally: A shared approach to tackling the problem of overuse in healthcare

Choosing Wisely, a campaign which launched in the United States in 2012, has now spread to over 20 countries around the world. Choosing Wisely campaigns share a core set of principles, which inform how campaigns operate and engage with physicians, clinicians, patients, and other stakeholders. This article will address the origins and motivation of Choosing Wisely campaigns, and what factors have supported their spread. It will also discuss how leaders of Choosing Wisely campaigns are collaborating on shared priorities.

The full article can be downloaded below.

Consumerism Will Spark Change Across the Industry: My Top Seven Health IT Predictions for 2019

As we prepare to take on the challenges and opportunities of a new year, let’s lay out some of the industry’s macro trends and what they might mean to us in 2019.

This year, there is a theme. As patients, we have an increasingly consumer-oriented mindset—and rightfully so. We’re paying closer attention to the quality and value we’re getting for the money we’re spending. This “consumerization” of healthcare, along with constant technology innovation, is driving a tectonic shift across the industry, and it’s easy to be excited about what the future holds. 

After nearly 40 years in this business, I’d better be getting good at reading between the lines to understand what’s coming next. So without further ado, here are my top seven health IT predictions for 2019.

1. Consumerization of healthcare reaches tipping point
2. Telehealth, mobility and millennials will upend the who and where of care delivery
3. Consumers will demand healthcare price transparency
4. People will insist on the ability to easily share their health data -- forcing the industry to accelerate interoperability solutions
5. Increased interoperability will propel value-based care
6. Initially driven by government regulations, the health IT industry will take the lead on battling the opioid epidemic
7. The healthcare market will demand easier, more appropriate access to high cost specialty drugs

The full Surescripts article can be viewed at this link.  

Patient and public involvement in medical performance processes: A systematic review

The significance and recognition of patient and public involvement (PPI) have grown in many domains of health care in recent years propagating an evolution of “patient-centred care” and shared clinical decision making. This review indicates a need for a similar level of integration for PPI within medical performance processes as existing models are both fragmented and inadequate to have a meaningful impact on systems and processes that assess and monitor performance.

Feedback and complaints have both summative and formative elements, though the balance varies between different systems and even within systems. PPI can make a positive contribution to developing both elements, although the evidence presented in this review suggests that most doctors would prefer patient feedback and complaints to provide a primarily formative assessment of their performance and are cautious about the use of such data for summative purposes. Developing the formative element of feedback and complaints mechanisms with patients involved in the design of their structures and systems may have a greater impact on the professional development of doctors.

More broadly, quality improvement may act as a driver for PPI in medical performance processes to evolve beyond the level of providing feedback and lodging complaints, forming the foundation of a transition from a culture of contractual PPI that exists as part of the clinical interface between the doctor and patient, to that of collaboration that enhances the profession-society relationship.

The full article can be downloaded below.  

Patient safety after implementation of a coproduced family centered communication programme: multicenter before and after intervention study

Families, nurses, and physicians coproduced an intervention to standardize healthcare provider-family communication on ward rounds (“family centered rounds”), which included structured, high reliability communication on bedside rounds emphasizing health literacy, family engagement, and bidirectional communication; structured, written real-time summaries of rounds; a formal training programme for healthcare providers; and strategies to support teamwork, implementation, and process improvement.

Although overall errors were unchanged, harmful medical errors decreased and family experience and communication processes improved after implementation of a structured communication intervention for family centered rounds coproduced by families, nurses, and physicians. Family centered care processes may improve safety and quality of care without negatively impacting teaching or duration of rounds.

The full article can be downloaded below.