Quality Improvement (QI) in the healthcare setting has evolved in recent years to improve outcomes in clinical practice.1 In 2010, the American Society of Clinical Oncology (ASCO) implemented the Quality Oncology Practice Initiative (QOPI®) Certification program to evaluate practice performance against quality measures and standards established by experts in the oncology field.2 Quality Improvement initiatives may lead to better patient outcomes, consistent high quality safe and effective care, and professional engagement in career development.
Clinical practice guidelines are most effective when based on best available research and clinical practices. With Advanced Practice Provider’s (APPs) advanced training and practice experience, they are positioned to play a key role in facilitating meaningful change. Serving as the Team Lead on a QI project allows APPs to develop leadership and management skills, build rapport with colleagues across the practice and take an active role in implementing best practices.
Busy day-to-day operations can be a barrier for providers in identifying areas within the clinical practice in need of improvement. By developing an organized framework for identifying problems, this assists in discovering areas in need of improvement and build lasting practice changes. Successful practice changes should be aimed at a specific, targetable goal.4 Several change management models exist to serve as framework for initiating a performance improvement project. Two commonly used models include Edward Deming’s PDSA: Plan, Do, Study, Act Model and the Lean Six Sigma Model which uses a five-step approach to process Define-Measure-Analyze-Improve-Control (DMAIC).1, 3
Components of a Quality Improvement Project
Organization and specificity are key components to a successful QI project. As a project Team Lead, the APP manages the project and ensures completion of the team’s tasks throughout the project. The first step in managing a QI project is outlining key project roles: Project Sponsor (leadership level that maintains overall responsibility, authority, accountability), Project Coordinator (assists in scheduling meetings and coordinating projects/logistics, documentation), and Project Members (stakeholders/experts), ideally a multi-disciplinary representation with members who are familiar with all areas of the process.1,4 The multi-disciplinary representation provides feedback on areas of the process providers or administrators may not be as familiar with.
While QI projects are an ongoing process, it is important to set the project scope, identifying where the project starts and ends, documenting important group milestones, and deadlines throughout the process. The Project Charter is an organized way to outline the overall objectives, implementation of quality improvement measures and who will be impacted (stakeholders).4 The key to successful outcomes in a QI project is to set realistic expectations. While it is tempting to have ambitious goals for improvement, the most lasting change comes when goals are specific and attainable.
Once the group is identified, further brainstorm the area of clinical practice in need of improvement. During this step, it is helpful to map the current existing process in its entirety. This allows a thorough look at all possible areas potentially contributing to a breakdown in the process. It is important to see this step through completion without concluding on solutions to a problem.
Next, develop an AIM statement defining what you are trying to accomplish. This can change as you further map and evaluate the process. By using the SMART goals technique, this can help ensure the goals are attainable and beneficial.4
- SMART goals
- Specific: Make the goal clear and precise
- Measurable: Can this be measured? How will this be measured? Do you have a baseline measurement?
- Actionable: Can this goal be acted upon? Is it manageable?
- Realistic: Is this within your practices ability to change? Are additional costs or resources involved? Are there higher priorities?
- Timely: Define a clear timeframe and target completion date.
After potential problems associated with a less desirable outcome are identified, a Fishbone diagram is a concise way to visualize all potential problems contributing to the process. This is useful in discovering root causes and recognizing key areas to target. Once the intervention is put into action, continue to monitor effectiveness.
The key component to a successful and lasting QI project, which leads to meaningful change, is an organized approach with a specific, measurable target that engages stakeholders to implement change and monitor outcomes. Overtime, this may result in outlining standardized high-quality clinical competencies across disciplines. Quality Improvement initiatives improve daily clinical and operational practices, reducing provider and staff burnout while improving the overall patient experience. By taking the role as Team Lead, APPs discover new information that can impact the healthcare system as a whole, leading to new opportunities to contribute to abstracts, manuscripts and poster presentation, furthering the role of the APP in both clinical practice and healthcare policies.
- Comfere NI, Matulis JC 3rd, O'Horo JC. Quality improvement and healthcare: The Mayo Clinic quality Academy experience. J Clin Tuberc Other Mycobact Dis. 2020;20:100170. Published 2020 Jun 13. doi:10.1016/j.jctube.2020.100170
- Twenty Oncology Practices Achieve ASCO’s QOPI® Certification in Second Quarter of 2019, ASCO News Releases, July 2019, Accessed September 14, 2020. https://www.asco.org/about-asco/press-center/news-releases/twenty-oncology-practices-achieve-ascos-qopi-certification.
- Peter Donnelly & Paul Kirk (2015) Use the PDSA model for effective change management, Education for Primary Care, 26:4, 279-281, DOI: 10.1080/14739879.2015.11494356
- Doran, G.T. (1981). “There’s a S.M.A.R.T. Way to Write Management’s Goals and Objectives”, Management Review, Vol. 70, Issue 11, pp. 35-36. Adapted for use by The University of Texas MD Anderson Cancer Center
- NEJM catalyst innovations in care delivery, NEJM News Brief. April 27, 2018. Accessed September 19, 2020. https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0193