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How do emergency departments and emergency leaders catalyze positive change through quality improvement collaborations?

  • Lucas B. Chartier (a1) (a2), Shawn E. Mondoux (a3) (a4), Antonia S. Stang (a5) (a6), Adam M. Dukelow (a7) (a8), Shawn K. Dowling (a9) (a10), Edmund S. H. Kwok (a11), Sachin V. Trivedi (a12), Joshua Tepper (a13) (a14) and Eddy Lang (a9) (a10)...

Abstract

Objectives

Quality Improvement and Patient Safety (QIPS) plays an important role in addressing shortcomings in optimal healthcare delivery. However, there is little published guidance available for emergency department (ED) teams with respect to developing their own QIPS programs. We sought to create recommendations for established and aspiring ED leaders to use as a pathway to better patient care through programmatic QIPS activities, starting internally and working towards interdepartmental collaboration.

Methods

An expert panel comprised of ten ED clinicians with QIPS and leadership expertise was established. A scoping review was conducted to identify published literature on establishing QIPS programs and frameworks in healthcare. Stakeholder consultations were conducted among Canadian healthcare leaders, and recommendations were drafted by the expert panel based on all the accumulated information. These were reviewed and refined at the 2018 CAEP Academic Symposium in Calgary using in-person and technologically-supported feedback.

Results

Recommendations include: creating a sense of urgency for improvement; engaging relevant stakeholders and leaders; creating a formal local QIPS Committee; securing funding and resources; obtaining local data to guide the work; supporting QIPS training for team members; encouraging interprofessional, cross-departmental, and patient collaborations; using an established QIPS framework to guide the work; developing reward mechanisms and incentive structures; and considering to start small by focusing on a project rather than a program.

Conclusion

A list of 10 recommendations is presented as guiding principles for the establishment and sustainable deployment of QIPS activities in EDs throughout Canada and abroad. ED leaders are encouraged to implement our recommendations in an effort to improve patient care.

Objectif

L'amélioration de la qualité et la sécurité des patients (AQSP) joue un rôle important dans la correction des lacunes observées dans la prestation optimale de soins. Toutefois, les équipes de soins au service des urgences (SU) disposent de peu de documentation sur la conception de leurs propres programmes d'AQSP. L’étude avait donc pour objectif l’élaboration de recommandations conçues à l'intention des chefs de file, nouveaux ou confirmés, au SU, et présentées comme une voie à emprunter pour améliorer les soins aux patients, par l'application d'activités programmatiques d'AQSP, tout d'abord au sein du service, puis entre services, grâce à la collaboration.

Méthode

Un groupe d'experts composé de 10 cliniciens en médecine d'urgence, ayant des compétences particulières en AQSP et en pouvoir d'influence, a été mis sur pied. Un examen de cadrage a été entrepris à la recherche de publications sur l’établissement de programmes d'AQSP et de cadres de travail s'y rapportant, en soins de santé. Des consultations ont été menées avec les parties intéressées parmi les chefs de file en soins de santé au Canada, et le groupe d'experts a rédigé une version préliminaire de recommandations fondées sur l'ensemble de l'information recueillie. Celles-ci ont été examinées et améliorées durant le Symposium sur les affaires universitaires 2018 de l'ACMU, à Calgary, à la suite de rétroactions communiquées en personne ou par voie électronique.

Résultats

Les recommandations portaient sur : l’éveil d'un sentiment d'urgence à l’égard de l'amélioration; la mobilisation d'intervenants et de chefs de file compétents; la mise sur pied d'un comité local structuré d'AQSP; l'obtention de financement et de ressources; la disponibilité de données locales pour orienter le travail; le soutien de la formation des membres d’équipe en AQSP; la promotion de la collaboration entre professions, entre services et avec les patients; l'utilisation d'un cadre de travail d'AQSP déjà établi afin d'orienter le travail; l’élaboration d'un système de récompenses et de structures incitatives; la possibilité d'entreprendre, au début, des initiatives à petite échelle, soit des projets plutôt que des programmes.

Conclusion

Les dix recommandations ont été présentées à titre de principes directeurs en vue de l’élaboration d'activités d'AQSP et de leur mise en œuvre durable dans les SU, au Canada et ailleurs dans le monde. Les chefs de file dans les SU sont invités à appliquer ces recommandations dans le but d'améliorer les soins aux patients.

Copyright

Corresponding author

Correspondence to: Dr. Lucas B Chartier, 200 Elizabeth St., RFE-GS-480, Toronto, ON, M5G 2C4; Email: lucas.chartier@uhn.ca

References

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1.Joint Commission. “Patient Safety System” Chapters. Jt Comm. December 18, 2017. Available at: https://www.jointcommission.org/assets/1/6/PS_chapter_AHC_2018.pdf (accessed September 6, 2018).
2.Forrest, CB, Glade, GB, Baker, AE, Bocian, A, von Schrader, S, Starfield, B. Coordination of specialty referrals and physician satisfaction with referral care. Arch Pediatr Adolesc Med 2000;154(5):499506.
3.Chartier, L, Josephson, T, Bates, K, Kuipers, M. Improving emergency department flow through rapid medical evaluation unit. BMJ Qual Improv Rep 2015;4(1).
4.Gandhi, TK, Sittig, DF, Franklin, M, Sussman, AJ, Fairchild, DG, Bates, DW. Communication breakdown in the outpatient referral process. J Gen Intern Med 2000;15(9):626–31.
5.Gandhi, TK. Fumbled handoffs: one dropped ball after another. Ann Intern Med 2005;142(5):352–8.
6.Schneider, EC, Sarnak, DO, Squires, D, Shah, A, Doty, MM. Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better US Health Care; 2017. Available at: https://interactives.commonwealthfund.org/2017/july/mirror-mirror/ (accessed April 11, 2019).
7.Schoen, C, Osborn, R, Doty, MM, Bishop, M, Peugh, J, Murukutla, N. Toward higher-performance health systems: adults’ health care experiences in seven countries, 2007. Health Aff (Millwood) 2007;26(6):w71734.
8.Stange, KC. The problem of fragmentation and the need for integrative solutions. Ann Fam Med 2009;7(2):100–3.
9.Kohn, L, Corrigan, J, Donaldson, M. To Err Is Human: Building a Safer Health System. (Committee on Quality of Health Care in America I of M, ed.). Washington, DC: National Academy Press; 2000.
10.Institute of Medicine, Committee on the Quality of Health Care in America. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001, https://doi.org/10.17226/10027.
11.Kwok, ES, Perry, JJ, Mondoux, S, Chartier, LB. An Environmental Scan of Quality Improvement and Patient Safety Activities in Emergency Medicine in Canada. CJEM 2019; epub, 10.1017/cem.2019.16
12.Reinertsen, JL, Bisognano, M, Pugh, MD. Seven Leadership Leverage Points for Organization-Level Improvement in Health Care (Second Edition). IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2008.
13.Nolan, TW. Execution of Strategic Improvement Initiatives to Produce System-Level Results. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007.
14.Welch, S, Klauer, K, Fontenor, SF. Setting up a Comprehensive Quality Improvement Program for your ED. Risk Management and the Emergency Department. Health Administration Press; 2011, 1730.
15.Boyle, A, Cleugh, F, Long, J, et al. Royal College of Emergency Medicine Quality Improvement Guide: A practical guide for clinicians undertaking quality improvement in Emergency Departments; 2016.
16.Reinertsen, JL, Gosfield, AG, Rupp, W, Whittington, JW. Engaging Physicians in a Shared Quality Agenda. IHI Innovation Series white paper. Cambridge, MA: Institute for Healthcare Improvement; 2007.
17.DeWalt, D, Powell, J, Mainwaring, B, et al. Practice coaching program manual. Princeton, NJ: Aligning Forces for Quality (AF4Q), George Washington University Medical Center; 2010.
18.Canadian Patient Safety Institute. Tips for patient engagement in patient safety and quality committees. CPSI. February 24, 2016. Available at: http://www.patientsafetyinstitute.ca/en/toolsResources/pages/pfpsc-patient-engagement-in-safety-committees.aspx (accessed September 6, 2018).
19.Institute for Healthcare Improvement. Science of Improvement: Forming the Team. IHI. June 6, 2012. Available at: http://www.ihi.org/resources/Pages/HowtoImprove/ScienceofImprovementFormingtheTeam.aspx (accessed September 6, 2018).
20.World Health Organization. Operations Manual for Staff at Primary Health Care Centres. Quality Improvement Chapter 11. December 2, 2008. Available at: http://www.who.int/hiv/pub/imai/om_11_quality_improvement.pdf (accessed September 6, 2018).
21.Kaplan, HC, Brady, PW, Dritz, MC, et al. The influence of context on quality improvement success in health care: a systematic review of the literature. Milbank Q 2010;88(4):500–59.
22.Alexander, JA, Hearld, LR. The science of quality improvement implementation: developing capacity to make a difference. Med Care 2011;49 Suppl:S620.
23.Kaplan, HC, Froehle, CM, Cassedy, A, Provost, LP, Margolis, PA. An exploratory analysis of the model for understanding success in quality. Health Care Manage Rev 2013;38(4):325–38.
24.Agency for Healthcare Research and Quality. The Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families. Rockville, MD: AHRQ; 2018. Available at: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-family-engagement/pfeprimarycare/pfepc-fullguide-final508.pdf (accessed September 6, 2018).
25.Singh, R, Pace, W, Singh, S, Singh, A, Singh, G. A concept for a visual computer interface to make error taxonomies useful at the point of primary care. Inform Prim Care 2007;15(4):221–9.
26.Farbstein, K, Clough, J. Improving medication safety across a multihospital system. Jt Comm J Qual Improv 2001;27(3):123–37.
27.Health Quality Ontario. Quality Improvement Guide. Toronto (ON): Queens Printer of Ontario; 2012.
28.Varkey, P, Reller, MK, Resar, RK. Basics of quality improvement in health care. Mayo Clin Proc 2007;82(6):735–9.
29.Kelly, JJ, Thallner, E, Broida, RI, et al. Emergency medicine quality improvement and patient safety curriculum. Acad Emerg Med 2010;17 Suppl 2:e11029.
30.Johnstone, PA, Hendrickson, JA, Dernbach, AJ, et al. Ancillary services in the health care industry: is Six Sigma reasonable? Qual Manag Health Care 2003;12(1):5363.
31.Frank, JR, Snell, L, Sherbino, J, eds. CanMEDS 2015 Physician Competency Framework. Ottawa: Royal College of Physicians and Surgeons of Canada; 2015.
32.Mondoux, SE, Chan, TM, Ankel, F, Sklar, DP. Teaching Quality Improvement in Emergency Medicine Training Programs: A Review of Best Practices. AEM E & T 2018;1(4).
33.Chartier, LB, Cheng, AH, Stang, AS, Vaillancourt, S. Quality improvement primer part 1: preparing for a quality improvement project in the emergency department. CJEM 2018;20(1):104–11.
34.Bryson, JM. Strategic Planning for Public and Nonprofit Organizations: A Guide to Strengthening and Sustaining Organizational Achievement. 3rd ed. San Francisco: Jossey-Bass; 2004.
35.The Point of Care Foundation. 2018. Available at: https://www.pointofcarefoundation.org.uk/resource/experience-based-co-design-ebcd-toolkit/ (accessed September 6, 2018).
36.Rotteau, L, Webster, F, Salkeld, E, et al. Ontario's ED improvement process program. Acad EM 2015;22(6):720–9.
37.Lynn, J, Baily, MA, Bottrell, M, et al. The ethics of using quality improvement methods in health care. Ann Intern Med 2007 May;146(9):666–73.
38.Batalden, PB, Davidoff, F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care 2007;16(1):23.
39.Berwick, DM. Developing and testing changes in delivery of care. Ann Intern Med 1998;128(8):651–6.
40.Chartier, LB, Vaillancourt, S, Cheng, AH, Stang, AS. Quality improvement primer part 3: evaluating and sustaining a quality improvement project in the emergency department. CJEM. 2019;21(2):261–68.
41.Ham, C, Kipping, R, McLeod, H. Redesigning work processes in health care: lessons from the National Health Service. Milbank Q 2003;81(3):415–39.
42.Scoville, R, Little, K, Rakover, J, Luther, K, Mate, K. Sustaining Improvement. IHI White Paper. Cambridge, MA: Institute for Healthcare Improvement; 2016.
43.Shojania, KG, Levinson, W. Clinicians in quality improvement: a new career pathway in academic medicine. JAMA 2009;301(7):766–8.
44.Mondoux, SE, Frank, JR, Kwok, ES, et al. Teaching M&M rounds skills: enhancing and assessing patient safety competencies using the Ottawa M&M model. Postgrad Med J 2016;92(1093):631–5.
45.Chartier, LB, Stang, AS, Vaillancourt, S, Cheng, AH. Quality improvement primer part 2: executing a quality improvement project in the emergency department. CJEM 2018;20(4):532–8.
46.Ogrinc, G, Davies, L, Goodman, D, et al. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process. BMJ Qual Saf 2016;25(12):986–92.
47.Institute for Healthcare Improvement. Open School. 2018. Available at: http://www.ihi.org/education/IHIOpenSchool/Pages/default.aspx (accessed September 6, 2018).

Keywords

How do emergency departments and emergency leaders catalyze positive change through quality improvement collaborations?

  • Lucas B. Chartier (a1) (a2), Shawn E. Mondoux (a3) (a4), Antonia S. Stang (a5) (a6), Adam M. Dukelow (a7) (a8), Shawn K. Dowling (a9) (a10), Edmund S. H. Kwok (a11), Sachin V. Trivedi (a12), Joshua Tepper (a13) (a14) and Eddy Lang (a9) (a10)...

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