Monday, May 11, 2020

IHI Forum Blog



Junzi Shi, MD
Resident in Radiology Diagnostic at BWH
PGY 5

01/27/2020
            
Junzi Shi, MD attends the 2019 IHI
National Forum in Orlando, Florida. 
“Experience teaches nothing without theory,” said W. Edwards Deming, one of the fathers of quality improvement, “In fact there is no experience to record without theory… Without theory there is no learning… And that is their downfall.” The science of improvement involves the interaction of systems thinking and theory of knowledge that are applied together, in order to develop, test, implement, and spread change. The ability to integrate quality improvement is key to making healthcare relevant, safe, and up to date with the needs of society at large.
           
I met inspiring leaders at the IHI forum at the Orlando Marriott World Center on Dec 9-11 including Abby Wambach, renowned soccer player, who encouraged us to “use failure as fuel.” At individual organizations, we often struggle with increasing engagement from shareholders within the healthcare organization. How do we fuel people to create change? How do we make QI a priority?

One of the talks that resonated with me was by a chief quality officer who sat by her father’s bedside every day when he was hospitalized, yet he still developed a number of preventable medical adverse events such as central line infection and upper extremity deep venous thrombosis and delirium. What is wrong with our system with someone who has been trained to look out for and prevent such events cannot even prevent them with her daily vigilance? When my mother was diagnosed with cancer, I felt like I went through cancer too. I was by her side every step of the way of the 3 year journey as she received various treatments. She also suffered from preventable medical errors such as lower extremity numbness and
One of the sessions featured Don Berwick (Middle) discussing
the foundations of quality improvement. 

paresthesias due to her oncologist forgetting to prescribe vitamin B6 and B12. She developed heart failure from poorly titrated drug dosages. She, as a nurse of 15 years, was baffled. I, as a medical student, blamed myself for not being diligent enough.

Becoming a conduit between disparate data points and knowledge is key to being a change leader. For example, one of the initiatives our department of radiology is participating in this year is the Promotion in Place project, which will assess metrics for advancing trainees while they are in residency training based on performance metrics. We will need to connect data point from models in Canada and from other training programs and feedback from our own trainees to determine the best course of action.

One key message that Don Berwick, past president of IHI, delivered at the forum was the importance of joy in our work. Part of achieving joy is to have the tools and support to do our work and part of it is having daily drivers as well as targeted training and tools. Empowered leaders are more engaged and able to build teams that complement each other. At every level of an organization, we can improve the workspace around us with conscientious actions. Most importantly, how can we make improvement part of the workflow? As Chief resident, one of my tasks is to help make 41 residents happy. We are constantly working on workflow issues including minimizing distractions, optimizing efficiency, and maximize learning. It was great to walk away from a meeting with new questions and aspirations. I hope to bring the knowledge and enthusiasm from IHI to the workplace as well as the next stage of my career.   
Summary for QA/QI best practices:

Foundation
-        Develop infrastructure: creating the structure to support quality
-        Create a culture that enables and activates people: creating the activities and environment that support people to act

Continuous practice
-        Plan: understand and design to meet the customer need
-        Improve: creating breakthroughs in improvement
-        Sustain: assuring predictable and reliable process

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