TOPIC 34: Quality Improvement Projects – Understand How to Develop a Quality Improvement Project in Clinical Practice
OFFICIAL ABP TOPIC:
Understand how to develop a quality improvement project in clinical practice
BACKGROUND
Quality improvement is a critical responsibility for pediatricians to continuously enhance healthcare quality. By engaging in QI initiatives, clinicians can identify and address performance gaps in their practices, ultimately elevating care delivery and outcomes for the children and families they serve.
DEVELOPING A QUALITY IMPROVEMENT PROJECT
Key steps in developing a clinical QI project include:
IDENTIFYING THE PROBLEM
Identify meaningful gaps in healthcare quality that could improve safety, effectiveness, timeliness, efficiency, equity, or patient-centeredness. Example: Clinic wait times (timeliness) exceed national benchmarks by 30 minutes.
FORMING A TEAM
- Recruit a respected leader with authority to facilitate change.
- Include diverse representatives (e.g., clinicians, staff, patients/families).
- Keep the team small (usually <8 members) for effective collaboration.
CREATING AN AIM STATEMENT
Craft a goal defining intended accomplishments using the SMART framework:
- Specific
- Measurable
- Achievable
- Relevant
- Time-bound
Example: “Increase the percentage of eligible pediatric patients receiving the HPV vaccine from 40% to 75% within 6 months.”
SELECTING MEASURES
Choose a balanced set of metrics tied directly to the aim statement.
|
MEASURE TYPE |
DEFINITION |
EXAMPLE |
|
Process |
Tracks steps to achieve an outcome |
% of patients receiving vaccine reminders |
|
Outcome |
Evaluates project success |
Increase in HPV vaccination rate |
|
Balancing |
Monitors unintended consequences |
Staff satisfaction with new vaccine workflows |
GENERATING CHANGE IDEAS
- Conduct literature reviews to identify evidence-based practices.
- Brainstorm with the team and stakeholders to find innovative solutions.
- Map out current processes using tools like the following:
|
TOOL |
PURPOSE |
EXAMPLE |
|
Process Flow Chart |
Map out current workflows to identify inefficiencies and gaps |
Analyzing patient registration processes to streamline cycle times |
|
Fishbone Diagram |
Explore potential root causes driving specific performance problems |
Examining underlying factors contributing to delays in care delivery |
|
Pareto Chart |
Stratify and prioritize improvement opportunities based on frequency or impact |
Determining the most common reasons for hand hygiene lapses to focus initial interventions |
TESTING CHANGES WITH THE PLAN-DO-STUDY-ACT (PDSA) CYCLE
The PDSA cycle is a foundational tool in QI that supports continuous improvement through iterative testing and learning.
- Plan: Design a small-scale test, make predictions, assign roles/tasks.
- Do: Implement the test, document observations and data.
- Study: Analyze results, compare to predictions, summarize learnings.
- Act: Refine the change idea, plan the next testing cycle.
By progressing through repeated PDSA cycles, improvement teams can refine interventions and build confidence to implement sustainable, large-scale enhancements.
IMPLEMENTING AND SPREADING IMPROVEMENTS
- Once changes demonstrate consistent improvement, implement them broadly.
- Continue data collection to monitor for regression.
- Spread enhanced processes to other suitable areas.
- Celebrate successes to maintain engagement and momentum.
SUSTAINING QI EFFORTS AND ENGAGING STAKEHOLDERS
STRATEGIES FOR SUSTAINABILITY
- Assign Process Ownership: Designate individuals responsible for maintaining new processes and monitoring performance.
- Integrate Improvements into Workflows: Build changes into staff onboarding, job descriptions, and standard operating procedures to ensure they become routine.
- Monitor Key Metrics: Continue tracking performance to identify potential regressions while scaling back data collection frequency.
ENGAGING STAKEHOLDERS
- Team Engagement: Hold regular team meetings to share progress, successes, and next steps. Solicit feedback from team members, including administrative staff and clinicians, to identify barriers and refine interventions.
- Patient and Family Feedback: Involve patients and families in identifying areas for improvement by collecting insights into care experiences.
- Celebrating Success: Publicly acknowledge team and individual contributions to maintain morale and motivation.
REFERENCES
https://www.abp.org/sites/public/files/pdf/qi-the-qi-guide.pdf