Starting off on the right foot: providing timely feedback to learners in quality improvement education

Extreme preterm birth is a major precursor to mortality and disability. Survival is improved in babies born in specialist centres but for multiple reasons this frequently does not occur. In the Thames Valley region of the UK in 2012–2014, covering 27 000 births per annum, about 50% of extremely premature babies were born in a specialist centre. Audit showed a number of potential areas for improvement. We used regional place of birth data and compared the place of birth of extremely premature babies for 2 years before our intervention and for 4 years (2014–2018) after we started. We aimed to improve the proportion of neonates born in a specialist centre with three interventions: increasing awareness and education across the region, by improving and simplifying the referral pathway to the local specialised centre, and by developing region-wide guidelines on the principal precursors to preterm birth: preterm labour and expedited delivery for fetal growth restriction. There were 147 eligible neonates born within the network in the 2 years before the intervention and 80 (54.4%) were inborn in a specialised centre. In the 4 years of and following the intervention, there were 334 neonates of whom 255 were inborn (76.3%) (relative risk of non-transfer 0.50 (95% CI 0.39 to 0.65), p<0.001). Rates showed a sustained improvement. The proportion of extremely premature babies born in specialist centres can be significantly improved by a region-wide quality improvement programme. The interventions and lessons could be used for other areas and specialties.

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Exploring the usefulness of Lexis diagrams for quality improvement

BMC Medical Informatics and Decision Making ◽

10.1186/s12911-019-1017-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Sara Dahlin

Keyword(s):

Quality Improvement ◽

Survival Data ◽

Gynecological Cancer ◽

Care Quality ◽

Care Process ◽

Related Factors ◽

Domain Experts ◽

Quality Registry ◽

Care Processes ◽

Timely Feedback

Abstract Background Visualization is important to aid practitioners in understanding local care processes and drive quality improvement (QI). Important aspects include timely feedback and ability to plot data over time. Moreover, the complexity of care also needs to be understood, as it affects the variation of care processes. However, there is a lack of QI methods visualizing multiple, related factors such as diagnosis date, death date, and cause of death to unravel their complexity, which is necessary to understand processes related to survival data. Lexis diagrams visualize individual patient processes as lines and mark additional factors such as key events. This study explores the potential of Lexis diagrams to support QI through survival data analysis, focusing on feedback, timeliness, and complexity, in a gynecological cancer setting in Sweden. Methods Lexis diagrams were produced based on data from a gynecological cancer quality registry (4481 patients). The usefulness of Lexis diagrams was explored through iterative data identification and analysis through semi-structured dialogues between the researcher and domain experts (clinically active care process owners) during five meetings. Visualizations were produced and adapted by the researcher between meetings, based on the dialogues, to ensure clinical relevance, resulting in three relevant types of visualizations. Results Domain experts identified different uses depending on diagnosis group and data visualization. Key results include timely feedback through close-to-real-time visualizations, supporting discussion and understanding of trends and hypothesis-building. Visualization of care process complexity facilitated evaluation of given care. Combined visualization of individual and population levels increased patient focus and may possibly also function to motivate practitioners and management. Conclusion Lexis diagrams can aid understanding of survival data, triggering important dialogues between care givers and supporting care quality improvement and new perspectives, and can therefore complement survival curves in quality improvement.

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Sustaining safety and delivery of oral chemotherapy utilizing lean methodology.

Journal of Clinical Oncology ◽

10.1200/jco.2020.39.28_suppl.218 ◽

2021 ◽

Vol 39 (28_suppl) ◽

pp. 218-218

Author(s):

Marc Steven Hoffmann ◽

Adam Neiberger ◽

Gloria Solis ◽

Marshall Johnson ◽

Debbie Fernandez

Keyword(s):

Quality Improvement ◽

Data Collection ◽

Safety Data ◽

Production Method ◽

Error Reduction ◽

Oral Chemotherapy ◽

Multidisciplinary Teams ◽

Care Providers ◽

Targeted Interventions ◽

The Right

218 Background: An oral chemotherapy safety event in 2017 prompted analysis of related workflows utilizing lean quality improvement methodology. Three kaizen workshops utilizing lean methodology with primary objectives to 1) develop safety standards for oral chemotherapy as rigorous as those for intravenous chemotherapy; 2) improve efficiency; and 3) design workflows that enable data collection and process control were conducted. Since 2017, our goal has been to sustain developed workflows to ensure oral chemotherapy patients have the right oral chemotherapy agent, at the right dose, at the right time, with independent and efficient safety checks by all care providers. Methods: After multidisciplinary teams participated in three kaizen workshops to develop workflows, education plans were developed and results were incorporated into the lean management system. The lean production method of Training Within Industry (TWI) was used to train physician, nursing, and pharmacy teams to the workflows. Results were communicated to key stakeholders weekly to monitor progress on workflow creation, spread, and process metrics designed to signal defects in the workflow. When processes were deemed ‘out of control,’ clinical team members provided regular and targeted interventions. Safety data were collected and correlated to surrogate outcomes for long-term impact assessment. Results: Interventions resulted in the following outcomes: 62 consecutive weeks with 99% reduction in oral chemotherapy defects reaching pharmacy. 86 consecutive weeks with 51% error reduction processing oral chemotherapy though a single EMR workflow. 57 consecutive weeks with 62% error reduction processing oral chemotherapy though a single EMR workflow. No serious safety events have occurred since 2017. Conclusions: Comprehensive quality improvement in our oral chemotherapy process has resulted in sustained safety, efficiency, and a data collection to signal when process defects occur. Multidisciplinary teams utilizing established lean methodology were critical to success.

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Clinical governance

Oxford Textbook of Obstetrics and Gynaecology ◽

10.1093/med/9780198766360.003.0005 ◽

2020 ◽

pp. 72-82

Author(s):

Leroy C. Edozien

Keyword(s):

Quality Improvement ◽

Clinical Practice ◽

Clinical Outcomes ◽

Patient Experience ◽

Clinical Governance ◽

Service Users ◽

Basic Principles ◽

Analyse Data ◽

Integrated Domains ◽

The Right

Clinical governance is the totality of structures and processes that are in place to ensure that, as far as practicable, the right person receives the right treatment, in the right way, at the right time, in the right place, with the right outcome. This goal does not happen by chance; it has to be secured by conscious effort, and that effort—creating and sustaining the required structures and processes—has to be actively and efficiently managed. This chapter describes the basic principles of clinical governance and provides a framework—the RADICAL framework—for delivering and monitoring clinical governance. The framework comprises the following domains: Raise awareness, Apply quality improvement methodology, Design for quality (including safety), Involve service users, Collect and Analyse data, and Learn from experience. The lofty aims of achieving optimal clinical outcomes and the best possible patient experience are best achieved when clinical practice addresses these integrated domains.

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