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| 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
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| 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
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Develop infrastructure: creating the structure
to support quality
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Create a culture that enables and activates
people: creating the activities and environment that support people to act
Continuous practice
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Plan: understand and design to meet the customer
need
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Improve: creating breakthroughs in improvement
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Sustain: assuring predictable and reliable process
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