Reflection (With Some Coaching) on a Quality Improvement Initiative: Finding Our Collective Voice Along the Journey.

Abstract

The Quality Improvement Success Story article by Roberts et al. (1) titled “Screening for Mental Health Comorbidities in a Pediatric Diabetes Clinic Setting” is a wonderful example of how the quality improvement (QI) lens can be focused on different kinds of outcomes. The clinic at Seattle Children’s Hospital elected to pursue improvement of its rate of mental health screening given the association of depression and diabetes distress with poor clinical outcomes such as A1C. Much is to be learned by their initiative and energies. I present below a top-10 list (in no particular order of importance) of my reflections on this project. The team used the plan-do-study-act (PDSA) methodology to create change. The PDSA process enables practices to create many small, iterative changes rather than focus on one large change, hope for the best, and remeasure at some point in the future. The multiple months between intervention, data collection, and change in the initiative by Roberts et al. was quite long. Ideally, small samples of data would be collected weekly to determine whether the intervention needed to be redesigned or deployed in a different manner. To gain that knowledge quickly, I encourage practices to have shorter cycle times between PDSA cycles. Much can be learned from simply looking at five randomly selected patients per week who were exposed to the intervention to see whether the intervention behaved as was intended. At the end of each week, team members can look at the results and ask themselves (the “A” in PDSA): “Should we Abandon the initiative, do it Again” (i.e., collect data for another week), Adapt it (i.e., tweak the design of the intervention and then study that change going forward), or Adopt it as a standard process because enough data have been collected to show that it is working …