Authors: Matthew Hacker Teper, Daniel Lee, Camilla Parpia, Aikta Verma
HiQuiPs is back with another instalment of Expert’s Corner! For this post, we had the opportunity to talk with Dr. Aikta Verma about quality improvement (QI) and quality culture in the Emergency Department (ED).
Dr. Verma is the Chief of the Department of Emergency Services at Sunnybrook Health Sciences Centre. She completed a Masters of Health Sciences in Health Administration with a specific interest in QI. She is also an Assistant Professor at the University of Toronto, and has been a champion of QI in the ED, especially regarding the integration of technology into clinical workflows.
Key insights from Dr. Verma’s experience are below:
Creating a culture of continuous QI
A culture of continuous QI is one that values collaboration, transparency, and staff empowerment. The goal is to build a culture where members of the healthcare community contribute to the continuous improvement of systems and, therefore, outcomes for patients.
A key component of any culture of QI is ensuring people feel comfortable reporting concerns, so system flaws can be identified and improved. To do this, three conditions are required:
Safety culture: Clinicians need to trust that they can bring up safety concerns without being blamed, punished or reprimanded.
Worth their while: Clinicians need to trust that, when they do raise a concern, it will be taken seriously. They need to feel like it’s “worth” the burden of identifying and reporting their concerns or areas for improvement.
Participation in solutions: It’s not enough to expect clinicians to flag problem areas – they should be encouraged to participate in the process of designing solutions as well.
From QI to a culture of quality
Building capacity for team members to conduct QI initiatives is only the first step in providing high quality care. One must work to integrate lessons learned from those QI initiatives into policy and adapted into clinical practice. Encouraging clinicians to follow new high quality guidelines requires a multimodal approach:
Engaging clinicians at every phase of the QI process: From problem identification to PDSA cycling to solution implementation, it’s important that to consult clinicians throughout the process of changing clinical practice guidelines.
Practicing knowledge translation (KT) in relevant – and recurring – ways: Sending one email to clinicians isn’t enough! When adopting QI initiatives from peer institutions, always practice KT in ways that are compatible with your institutional culture.
Availing information for clinicians when it’s needed: There is nothing more essential than giving clinicians easy access to information when they need it. One way to do this is by integrating information into the electronic medical record (EMR) system (e.g., integrating new inclusion criteria into referral portals or using a force function that makes clinicians click through a verification process before ordering medications for a patient if there is a another patient with a similar/same name in the department).
Having policies and processes in a place that clinicians can access in real-time: Real-time, searchable, easy-to-use tools (e.g., My ED app) can help clinicians locate hospital-specific protocols with ease.
Tips for future QI leaders
QI is at the root of the job description of a hospital administrator, but it doesn’t always come naturally – it’s a skill that needs to be developed. One way to build your “QI muscle” is through formal training. Formal training teaches you, amongst many other things, how to rigorously evaluate a QI initiative. While it’s important that the QI changes you implement are easy-to-use, it’s also important to prove your change’s impact through qualitative and/or quantitative methodology.
Editor's note: there are many formal QI training programs for you to choose from. If you're looking to take your QI practice to the next level, consider applying to our HiQuiPs Incubator!
Another important lesson is that while QI is an effective way to improve patient safety, it also takes time. As you plan your next QI project, be patient and intentional in the decisions you make. One way to expedite the QI project is to keep up to date with the QI literature and what your national and international peers are doing. Developing relationships with peer institutions will allow you to adapt solutions to your local population.
Ultimately, QI is at the heart of quality patient care. While building a culture of quality (and QI) can seem daunting, doing so has the potential to dramatically improve the safety of patients. By welcoming ideas for system improvements, encouraging clinician participation, practicing high-value KT, using technology to integrate new innovations into clinical workflows and more, you can foster a culture that prioritizes patient safety, innovation, and evidence-informed patient care.
Senior Editor: Lucas Chartier
Copyedited by: Camilla Parpia