Residency and Fellowship

This may sound all too simple, obvious and straight-forward. However, the right project can be easily misconceived with the best intentions. Choose projects where you, as the project leader, can have strong influence and make effective change. The project should focus on a process or a condition that is relatively important (by prevalence and/or impact) for the particular service area. The project goal(s) should also be realistic and have a strong potential for improvement. Whenever possible, choose a project whose goals also align with those of the institution as well as other local, regional, and national healthcare agencies. This will provide you with more support for instituting your changes throughout the institution.

This may sound all too simple, obvious and straight-forward. However, the right project can be easily misconceived with the best intentions. Choose projects where you, as the project leader, can have strong influence and make effective change. The project should focus on a process or a condition that is relatively important (by prevalence and/or impact) for the particular service area. The project goal(s) should also be realistic and have a strong potential for improvement. Whenever possible, choose a project whose goals also align with those of the institution as well as other local, regional, and national healthcare agencies. This will provide you with more support for instituting your changes throughout the institution.

This is a critical element to complete before proceeding with any project. Once you’ve chosen a project and assembled your team, make sure to determine exactly where the current process/system stands in terms of the outcomes that you are striving to improve. In other words, what is your current baseline performance? You may come to realize that there is very little room for improvement and may decide to change the focus of your project or even change the project in its entirety.

You will need to create a concise yet definable aim statement. Using the SMART aim acronym, your objectives should be: Specific (be precise about what your team is doing), Measurable (quantify your objectives as a measurable goal) , Achievable (select a goal that you can realistically reach), Relevant (your goal should be instrumental to the overall mission of the hospital) and Timely (Identify a timeline for your project to reach its goal).

When choosing interventions, differentiate between tasks and tests. Tasks are “low hanging fruit,” interventions everyone agrees should be done and can’t understand why we aren’t doing it that way already. Tests are interventions that may or may not improve the outcomes we are investigating. For these, start small (i.e. one nurse on one shift for one patient) and perform multiple PDSA cycles to ensure that you are rolling out the best possible intervention that has been tested with data. For tests, check your balancing measures: things you could inadvertently make worse by instituting your intervention.

Making change happen effectively and consistently at the workplace is always difficult. You will need individuals who can help roll out the new changes to a larger group of providers. Sustaining these changes is even more challenging. Find key players who will partner with you for this successful transformation. These individuals do not need to be the most senior or authoritative people in your hospital. They do, however, need to have the skills and capabilities to influence change and the respect from front-line staff to influence their behaviors.

When measuring your process changes and your outcomes, stick to a simple and consistent methodology to collect this data. Inconsistencies in your measurement methodology will always lead to inaccurate, unreliable, and inconclusive data.

When measuring your process changes and your outcomes, stick to a simple and consistent methodology to collect this data. Inconsistencies in your measurement methodology will always lead to inaccurate, unreliable, and inconclusive data.

Once you’ve started your project, keep all the team members as well as other key stakeholders informed of the project’s goals and outcomes. Your project may also undergo several changes and variations throughout your journey. These changes will need to be communicated effectively and efficiently. Your team will need to see how their efforts are resulting in the outcomes that you initially intended for. Without this acknowledgement, their efforts at making and sustaining a change will inevitably wane. Check in with front-line providers to appreciate what they understand about the project, what they see as persistent obstacles and how you can help them work smarter, not harder for better patient outcomes.

Getting the team to believe in what and why you have chosen a particular QI project may take a long time. Even at the onset, team members may want to participate because they see a clear need for improvement but not necessarily “buy-in” to the entire project. Getting “buy-in” requires a complete understanding and belief that what you are doing (your interventions) is having a clear impact on the outcomes for your patients, families, and the healthcare delivery system. Understand the WIFM (What’s In It For Me) for each participant. Encouragement, perseverance, and determination all play a vital role in achieving this “buy-in”. Don’t forget, celebrate your success.