Systems-based Practice – AHSS QI Project

As part of our fourth year curriculum, medical students are responsible for taking on a quality improvement project. The purpose of this project is to identify a particular area within the hospital system that warrants closer observation and to critically assess ways to improve its function. At first glance, this can appear to be a particularly difficult task given the complexity of the hospital system and all of its component parts. There is a large interdependence required of these parts to have a fully functioning hospital system and this can make it difficult to identify specific areas of improvement. This, however, is exactly why it is so necessary for medical students to be exposed to quality improvement projects at this point in our training. We are able to learn how to effectively break down a complex problem and move forward with strategies for improvement with the feedback and guidance we receive from faculty.

 

My group chose to look into foley reinsertion rates on epidural PCA post-surgical patients. Prior to starting our project, we received significantly useful documents to help in guiding us map out our plan of action and how to successfully move towards our goal of identifying causes and implementing interventions. We were introduced to the DMAIC roadmap, which stands for “Define, Measure, Analyze, Improve and Control”. Over the course of the year, our group has been working through these individual steps. We defined our problem and created a process flowchart identifying the steps in this particular process that we were looking into. We then planned and executed a data collection plan by identifying key aspects that we intended to measure. We have recently been exploring root causes as well as potential solutions to decreased foley reinsertion rates and ways to implement these solutions, including an educational plan that we would deliver to all those involved. We then hope to monitor the performance of our implementations and will complete our project with a summary of our findings. Our project has come across some unforeseen challenges, including coordinating meeting times that work with everyone’s schedule, and it has required the synchronized efforts of multiple people within our group as well as those involved in a supportive role. We have divided responsibilities equally amongst group members and have remained in communication with one another so as to complete our individual tasks and work towards our common goal more efficiently. We are closing in on the final presentation of our project and it has been a thoroughly educational experience on how to design and implement studies of this nature moving forward.

 

I believe residency will offer me more opportunities to help improve the quality of the hospital system I am affiliated with. I believe this to be an important part of our job – to not only identify areas of improvement but lead in the implementation of well-organized plans of action. I will take what I have learned in my medical school QI project and expand on that in residency. Namely, I believe it’s vitally important for members of a project to have clearly defined roles and a means for open communication so that we are all able to move forward effectively in our individual roles while working towards our common goal. In a sense, a group research project acts as a microcosm of something far more complicated like a hospital system. It requires a synchronicity between interdependent components and a means of internal review. Beyond that, I’ve learned that a large part of identifying problems begins simply with talking to people. What are roadblocks that affect nursing in their day-to-day lives? Is there a common cause for extended stays in a particular service? Where do individual members of a team feel communication breaks down, if they feel that it does? Asking questions is a simple, but truly powerful way to begin the process of quality improvement and I plan on bringing an inquisitive nature with me wherever I go next.

 

AHSS Evaluations