Abstract
Background: Clarity in directions and constant engagement efforts are crucial to implementing high-quality interventions in Quality Improvement (QI) initiatives. It underpins the success to achieve impactful improvement, effectiveness of interventions through clinical leadership and project sustainability. Our objective was to implement a QI roadmap to improve QI participation of specialists and to clearly align projects and stakeholders to achieve departmental priorities and goals.Methods: Baseline measurement of Department of Internal Medicine (DIM) specialists involved in QI projects was performed. Root cause analysis and prioritization was conducted to determine the interventions. Series of interventions to address challenges faced by stakeholders to ensure congruency of directions that included collective learning sessions, planning of communication, and documenting progress with checkpoint meetings were carried out. A survey was conducted before and after interventions.Results: QI projects' participation rates of DIM specialists increased to 82.6% from 26.3% with an increase in uptake in leadership roles from three to nine specialists within the 12 months. The perception survey showed a positive shift in attitudes with greater ease in applying QI tools and concepts, with an increase of 25.7% in 2020 as compared to 2018. With the ease of completing QI projects, DIM specialists became more confident after intervention at 63.2% compared to 42.1% before and also regarded the department to be much stronger in QI culture with an improvement of 51.2%. DIM QI strategic themes model was borne from developing the core focus areas of the departments in order to align existing and prospective QI projects to the established themes.Conclusion: Department-specific goals and priorities with dedicated interventions are important in driving the interest and ownership to initiate QI projects that align to solve operational problems. The ease in creating the strategic themes model targeting key performance indicators and matching QI projects to the relevant themes, lowers activation barrier and promotes spread due to its simplicity to create and use for communication.
Highlights
The benefits of applying Quality Improvement (QI) principles in clinical practice have been widely reported with significant improvements to patient care aspects such as care coordination, safety, operational efficiency and access to care, in order to deliver the best care and value to the patient [1]
Aspects relating to perception surveys, number of Department of Internal Medicine (DIM) QI projects, number of DIM specialists involved in the QI projects and number of DIM specialists in project leadership roles would be the primary measures to assess the effectiveness of the interventions
The step was to establish relevant levers or indicators that would contribute to the success of the listed priority e.g., optimising ward operations would entail reducing Average Length of Stay (ALOS) in order to bring create bed savings for more acute cases to be admitted
Summary
The benefits of applying Quality Improvement (QI) principles in clinical practice have been widely reported with significant improvements to patient care aspects such as care coordination, safety, operational efficiency and access to care, in order to deliver the best care and value to the patient [1]. There is no universal solution for health care delivery organizations seeking to develop and implement effective educational strategies and plans focusing on quality improvement [4]. The high clinical workload, delayed discharge processes due to fragmentation of care and patients’ poor understanding of their conditions, contributed to the perpetual challenge of balancing service and residency training needs. Clarity in directions and constant engagement efforts are crucial to implementing high-quality interventions in Quality Improvement (QI) initiatives. It underpins the success to achieve impactful improvement, effectiveness of interventions through clinical leadership and project sustainability. Our objective was to implement a QI roadmap to improve QI participation of specialists and to clearly align projects and stakeholders to achieve departmental priorities and goals
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