scholarly journals Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care

2020 ◽  
Vol 9 (1) ◽  
pp. e000749 ◽  
Author(s):  
Eve Isabelle Purdy ◽  
Darren McLean ◽  
Charlotte Alexander ◽  
Matthew Scott ◽  
Andrew Donohue ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Trauma Care ◽  
Participant Observation ◽  
University Hospital ◽  
Relational Coordination ◽  
Care Providers ◽  
Coordinated Care ◽  
Patient Journey ◽  
Quality Improvement Process ◽  
Targeted Interventions

BackgroundTrauma care represents a complex patient journey, requiring multidisciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, co-operation and coordination across diverse groups. We aimed to define and improve relational aspects of trauma care at Gold Coast University Hospital.MethodsWe conducted a mixed-methods collaborative ethnography using the relational coordination survey—an established tool to analyse the relational dimensions of multidisciplinary teamwork—participant observation, interviews and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance.FindingsWe engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation programme in contributing positively to team culture and relational ties. A range of 16 interventions—focusing on structural, process and relational dimensions—were co-created with participants and are now being implemented and evaluated by various trauma care providers.ConclusionsThrough engagement of clinicians spanning organisational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage healthcare leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.

scholarly journals P045: Doing our work better, together: a relationship-based approach to defining the quality improvement agenda in trauma care

CJEM ◽  
2020 ◽  
Vol 22 (S1) ◽  
pp. S80-S80
Author(s):  
E. Purdy ◽  
D. Mclean ◽  
C. Alexander ◽  
M. Scott ◽  
A. Donahue ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Trauma Care ◽  
Participant Observation ◽  
Tertiary Care ◽  
Care Hospital ◽  
Relational Coordination ◽  
Care Providers ◽  
Coordinated Care ◽  
Patient Journey ◽  
Targeted Interventions

Background: Trauma care represents a complex patient journey, requiring multi-disciplinary coordinated care. Team members are human, and as such, how they feel about their colleagues and their work affects performance. The challenge for health service leaders is enabling culture that supports high levels of collaboration, cooperation and coordination across diverse groups. Aim Statement: We aimed to define and set the agenda for improvement of the relational aspects of trauma care at a large tertiary care hospital. Measures & Design: We conducted a mixed-methods collaborative ethnography using the Relational Coordination survey – an established tool to analyze the relational dimensions of multidisciplinary teamwork – participant observation, interviews, and narrative surveys. Findings were presented to clinicians in working groups for further interpretation and to facilitate co-creation of targeted interventions designed to improve team relationships and performance. Evaluation/Results: We engaged a complex multidisciplinary network of ~500 care providers dispersed across seven core interdependent clinical disciplines. Initial findings highlighted the importance of relationships in trauma care and opportunities to improve. Narrative survey and ethnographic findings further highlighted the centrality of a translational simulation program in contributing positively to team culture and relational ties. A range of 16 interventions – focusing on structural, process and relational dimensions – were co-created with participants and are now being implemented and evaluated by various trauma care providers. Discussion/Impact: Through engagement of clinicians spanning organizational boundaries, relational aspects of care can be measured and directly targeted in a collaborative quality improvement process. We encourage health care leaders to consider relationship-based quality improvement strategies, including translational simulation and relational coordination processes, in their efforts to improve care for patients with complex, interdependent journeys.

scholarly journals Improving patient flow in a regional anaesthesia block room

2019 ◽  
Vol 8 (2) ◽  
pp. e000346 ◽  
Author(s):  
Brigid Brown ◽  
Ekta Khemani ◽  
Cheng Lin ◽  
Kevin Armstrong
Keyword(s):  
Quality Improvement ◽  
Regional Anaesthesia ◽  
Time Pressure ◽  
Patient Flow ◽  
University Hospital ◽  
Patient Journey ◽  
Improvement Project ◽  
Quality Improvement Process ◽  
Entry Time ◽  
Patient Arrival

University Hospital is a tertiary academic centre in London, Ontario, Canada. A designated space known as the block room (BR) supports a model of care to perform regional anaesthesia prior to entering the resource intense operating room (OR). Stress due to time pressure was reported by BR staff. It was presumed that upstream delays in patient admission, preparation, transportation and in the BR resulted in late OR starts. There was limited data for a patient’s preoperative transit at our institution. A prospective quality improvement project was conceived to understand and address concerns surrounding patient flow. Using Plan–Do–Study–Act (PDSA) methodology, we collected baseline data of patients perioperative transit and performed three PDSA cycles for improvement. We established targets for OR entry time and patient arrival to the BR. We examined communication between the surgical preparation unit, BRandORs, involved stakeholders in decision making and continuously sourced feedback for improvement. Over three incremental rapid PDSA cycles and reaudit of our baseline, we found a statistically significant improvement in patients arriving to the BR 60 min prior to the scheduled OR time from a baseline of 31%–53% (p=0.04) and patient operations commencing on time improved from 52% to 65% (p=0.03). The availability of patients in the BR within 15 min of a decision to have them available reached 98% from a baseline of 69% (p<0.001). As a result of the quality improvement process, we were able to significantly improve the flow of the preoperative patient journey at our institution. With a better understanding of complex preoperative processes, we can strategically intervene and potentially improve efficiency, morale and safety.

scholarly journals Crossing Knowledge Boundaries: Health Care Providers’ Perceptions and Experiences of What is Important to Achieve More Person-Centered Patient Pathways For Older People

2021 ◽  
Author(s):  
Cecilie Olsen ◽  
Astrid Bergland ◽  
Asta Bye ◽  
Jonas Debesay ◽  
Anne Langaas
Keyword(s):  
Health Care ◽  
Quality Improvement ◽  
Older People ◽  
Health Care Providers ◽  
Transitional Care ◽  
Care Providers ◽  
Quality Improvement Collaborative ◽  
Patient Journey ◽  
Patient Pathways

Abstract Background: Improving the transitional care of older people, especially hospital-to-home transitions, is a salient concern worldwide. Older people’s patient pathways may be unpredictable and complex, posing significant challenges for health care providers (HCPs). In particular, appropriate follow-up in primary care after discharge is key. Current research in the field endorses person-centered care as crucial to improving the patient pathways of older people. The aim of this study was to explore HCPs’ perceptions and experiences of what is important to achieve more person-centered patient pathways for older people.Methods: This was a qualitative study. We performed individual semistructured interviews with 20 HCPs and three key persons who participated in a Norwegian quality improvement collaborative. In addition, participant observation of 22 meetings in the quality improvement collaborative was performed. Results: A thematic analysis resulted in five themes: 1) Finding common ground through the mapping of the patient journey; 2) the importance of understanding the whole patient pathway; 3) the significance of getting to know the older patient; 4) the key role of home care providers in the patient pathways of older people; and 5) ambiguity toward checklists and practice implementation. Conclusion: To understand the findings, it proved useful to see them in light of knowledge sharing and boundary crossing, which are central concepts in the literature on transitional care. HCPs in the collaborative shared and coproduced new knowledge of the patient pathways of older people based on a patient journey perspective. Mapping the patient journey and asking, “What matters to you?” facilitated the crossing of knowledge boundaries between the HCPs; hence, a new and more holistic view of the patient pathways of older people in the current context emerged. The centrality of getting to know the patient and the special role of providers working in home care services was a central finding. The study adds to existing knowledge by suggesting that the achievement of person-centered patient pathways for older people does not only depend on the crossing of knowledge boundaries among HCPs, but also between HCPs and older persons.

Sustaining safety and delivery of oral chemotherapy utilizing lean methodology.

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.

Status of trauma quality improvement programs in the Americas: a survey of trauma care providers

2017 ◽  
Vol 220 ◽  
pp. 213-222 ◽  
Author(s):  
Hilary L. Zetlen ◽  
Lacey N. LaGrone ◽  
Jorge Esteban Foianini ◽  
Eduardo Huaman Egoavil ◽  
Jorge Sproviero ◽  
...  
Keyword(s):  
Quality Improvement ◽  
Trauma Care ◽  
Care Providers ◽  
Improvement Programs ◽  
Quality Improvement Programs

scholarly journals Initial steps to measurement and improvement of family-centered communication during the pediatric patient journey of bone marrow transplantation

2020 ◽  
pp. 488-504
Keyword(s):  
Quality Improvement ◽  
Healthcare System ◽  
Health Care Providers ◽  
Quality Improvement Initiative ◽  
Inpatient Setting ◽  
Care Providers ◽  
Patient Journey ◽  
Family Centeredness ◽  
Centered Care ◽  
Family Centered

Often, pediatric patients' caregivers feel like they are not being heard or consulted by the healthcare system they have entrusted for their loved ones’ care. These difficulties are well known to the healthcare system, and significant research has been conducted to understand how to provide what’s come to be known as patient- and family-centered care (PFCC). PFCC is grounded in mutually beneficial partnerships among health care providers, patients, and families. In 2019 we started a quality improvement initiative, partnering with families to increase our family-centeredness, initially focusing on communication. We report our quality improvement initiative's initial steps to understand communication between patients and caregivers in the inpatient setting. We report variables identified as barriers to PFCC, and our initial interventions, including small tests of change, to implement and improve PFCC in the inpatient setting. We hope that our experience will inspire others to undertake similar initiatives at their institutions.

scholarly journals Clinical governance and continuous Quality Improvement in the veterinary profession: A mixed-method study

2021 ◽  
Vol 6 (2) ◽  
Author(s):  
Tom Ling ◽  
Ashley Doorly ◽  
Chris Gush ◽  
Lucy Hocking
Keyword(s):  
Quality Improvement ◽  
Clinical Governance ◽  
Team Work ◽  
Care Providers ◽  
Formal Approach ◽  
Patient Journey ◽  
Just Culture ◽  
Continuous Quality ◽  
Veterinary Profession ◽  
Management Positions

96% of the veterinary profession agrees that Quality Improvement improves veterinary care. While clinical governance is an RCVS professional requirement, over the last year only 60% spent up to 3 days on the quality improvement activities which allow clinical governance to take place. 11% spent no time on it at all. A lack of time, know-how and organisational support were among the barriers preventing its adoption in practice. Rather than being an individual reaction to a problem, Quality Improvement is a formal approach to embedding a set of recognised practices, including clinical audit, significant event audit, guidelines and protocols, benchmarking and checklists. This framework should be applied within a just culture where errors are redefined as learning opportunities, and precedence is given to communication, team-work and team-morale, patient safety, and distributed leadership. Addressing this gap will require evolution – rather than a revolution. Persistent packages, given enough time and addressing the whole flow of the patient journey, trump one-off ‘heroic’ and narrowly-focused interventions. Creating a rhythm of learning alongside stability of practice allows lessons to be absorbed and improvements routinised. Doing good things well is better than doing perfect things sporadically and helps address the widespread concern that there is insufficient time for QI by making the time commitment more predictable and manageable. The research provides a robust, evidence-based, roadmap for the entire sector including professional organisations, educators, those in management positions and care providers.  

Improving Access to Integrated Behavioral Health in a Nurse-Led Federally Qualified Health Center

2021 ◽  
pp. 107839032199416
Author(s):  
Sarah Stalder ◽  
Aimee Techau ◽  
Jenny Hamilton ◽  
Carlo Caballero ◽  
Mary Weber ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Behavioral Health ◽  
Behavioral Health Care ◽  
Primary Care Providers ◽  
Care Team ◽  
Psychiatric Nurse ◽  
Care Providers ◽  
Team Members ◽  
Task Forces

BACKGROUND: The specific aims of this project were to create a fully integrated, nurse-led model of a psychiatric nurse practitioner and behavioral health care team within primary care to facilitate (1) patients receiving an appropriate level of care and (2) care team members performing at the top of their scope of practice. METHOD: The guiding model for process implementation was Rapid Cycle Quality Improvement. Three task forces were established to develop interventions in the areas of Roles and Responsibilities, Training and Implementation, and the electronic health record. INTERVENTION: The four interventions that emerged from these task forces were (1) the establishment of patient tiers based on diagnosis, medications, and risk assessment; (2) the creation of process maps to engage care team members; (3) just-in-time education regarding psychiatric medication management for primary care providers; and (4) use of a registry to track patients. RESULTS: The process measures of referrals to the psychiatric care team and psychiatric assessment intakes performed as expected. Both measures were higher at the onset of the project and lower 1 year later. The outcome indicator, number of case reviews, increased dramatically over time. CONCLUSIONS: For psychiatric nurse practitioners, this quality improvement effort provides evidence that a consultative role can be effective in supporting primary care providers. Through providing education, establishing patient tiers, and establishing an effective workflow, more patients may have access to psychiatric services.

scholarly journals Coassessment framework to identify person-centred unmet needs in stroke rehabilitation: a case report in Norway

2020 ◽  
Vol 7 (1) ◽  
pp. 148-156
Author(s):  
Kari Jorunn Kværner ◽  
Linn Nathalie Støme ◽  
Jonathan Romm ◽  
Karianne Rygh ◽  
Frida Almquist ◽  
...  
Keyword(s):  
Cognitive Impairment ◽  
Stroke Rehabilitation ◽  
Unmet Needs ◽  
Health Workers ◽  
University Hospital ◽  
Health Staff ◽  
Hospital Workers ◽  
Next Of Kin ◽  
Patient Journey ◽  
Health Value

ObjectiveTo describe unmet needs and values in stroke rehabilitation using the Health Value Framework and the associated coassessment tool Health Value Spider, a framework designed to identify and prioritise unmet needs based on health technology assessment (HTA).SettingThe study took place at Oslo University Hospital, Norway, from February to April 2019. Participants in three consecutive workshops were recruited from Sunnaas Rehabilitation Hospital, Oslo Municipality, Hospital Procurement Trust and Oslo University Hospital. Twenty-four hospital workers (medical and allied health staff and administrative staff) participated in workshop 1 and 29 patients, user representatives and hospital workers in workshop 2. Twenty-one patients and hospital workers participated in workshop 3.InterventionsStakeholder analysis and scenario building was performed in a coassessment setting where unmet needs were identified applying the Health Value Framework. Two of the authors are also the developers of the Health Value Framework (KJK and LNS).ResultsIn the two first workshops where health workers, patients and next of kin perspectives were elicited, three needs were identified: patient insecurity in patient journey transitions, lack of stroke rehabilitation expertise in primary care and invisible patient problems, such as fatigue and cognitive impairment. In workshop 3, 12 opportunity areas were identified. Four opportunity areas were selected by the stakeholders based on a prioritisation process: early discovery of cognitive impairment, rehabilitation continuity, empowered patients and next of kin and remote monitoring and digital touchpoints.ConclusionHealth Value Spider successfully identified and prioritised unmet needs and described associated values.

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