By Kevin J. O'Leary, MD, MS, Associate Vice Chair for Quality, Department of Medicine, Chief of Hospital Medicine in the Department of Medicine, John T. Clarke Professor of Medicine, Hospital Medicine
Although an increasing number of students and trainees in health care professions are receiving quality improvement (QI) education, many practicing professionals have not.
Therefore, relatively few practicing health care professionals are equipped to lead QI or serve as mentors for others. Perhaps more importantly, little is known about the effect of QI education programs on participants’ subsequent engagement in QI activities.
A new study in the Joint Commission Journal on Quality and Patient Safety reports the development, implementation, expansion and evaluation of the Northwestern Medicine Academy for Quality and Safety Improvement (AQSI) program.
AQSI was originally launched in 2013 in the Central Region of Northwestern Medicine, targeting professionals at Northwestern Memorial Hospital and affiliated practices. Beginning in 2017, AQSI expanded to include professionals at all 10 hospitals and practices affiliated with Northwestern Medicine. Over eight years, 80 teams and 441 individuals have participated in AQSI. Most AQSI participants have not had any prior QI training or experience.
We are honored to receive the 2020 John M. Eisenberg Award for Innovation in Patient Safety and Quality at the Local Level for the AQSI program, which aims to prepare individuals from multiple departments and professions in our health system to lead QI. During the seven month program, teams of participants learn about core quality topics and Six Sigma/Define, Measure, Analyze, Improve, Control (DMAIC), our health system’s performance improvement method. Teams also work on a project during the program with the goal of implementing interventions with enough time to see results by the end of the program. Teams receive ample support for their projects, including a performance improvement coach and help in getting data and making changes in our electronic health record. Teams receive feedback on their progress during report-outs to one another and to Improvement Council, which consists of system QI leaders.
One of the most important features of the AQSI program is that it is interprofessional and interdepartmental. Physicians at various stages of their careers participate, along with nurses, advanced practice providers, pharmacists, social workers and therapists. Overall, 80% of teams include members from more than one professional background, and 66% of teams have members from more than one clinical department.
Importantly, AQSI teams work on projects of their choosing. Most AQSI teams address problems team members have identified as frustrations for themselves or their patients. Many of these problems would not be addressed without the dedication and effort of the AQSI project teams.
The AQSI program has shown increased participant QI knowledge and improvements in clinical quality measures. Example projects include the following:
- Frailty in trauma patients: One team focused on improving care for frail patients admitted to the trauma surgery service. The team implemented a frailty screening tool and order set for patients identified as frail. The interventions resulted in a reduction in length of stay from 16 to 14 days and readmissions from 36% to 14%.
- Opioid prescriptions in the emergency department: Another team focused on reducing new prescriptions of opioid medications to patients discharged from the emergency department. The team provided evidence-based education and implemented a monthly audit and feedback report so that all emergency medicine physicians could see their individual opioid prescription rates related to peers. The interventions resulted in a reduction in opioid prescription rate from 8.6% to 5.8%.
• Use of interpreter services: A final team sought to increase the use of interpreter services for hospitalized medical patients with limited English proficiency (LEP). The team procured two additional iPads for video interpretation services and created a daily report so that interpreters could identify LEP patients and coordinate their services with primary clinical teams. The interventions resulted in an increase of interpreter services use from 60% to 78% of encounters.
The AQSI program has provided new knowledge and skills to participants which further improves the quality of care. Surveys of participants 18 months after completing the program show 74% collaborated on subsequent QI efforts, 43% led subsequent QI projects, and 42% had mentored others in QI. Other large health systems may use a similar approach to successfully train health care professionals across a range of specialties, settings and backgrounds to lead QI.
Kevin J. O'Leary, MD, MS is Chief of the Division of Hospital Medicine, Associate Chair for Quality in the Department of Medicine, and Medical Director for Quality for Northwestern Memorial Hospital. He is the founding Director of the Northwestern Medicine Academy for Quality and Safety Improvement (NM AQSI), a professional development program to train leaders in quality improvement. In 2015, AQSI received the Leape Ahead Award from the American Association for Physician Leadership. AQSI also received a 2020 John M. Eisenberg Award for Innovation in Patient Safety and Quality at the Local Level from The Joint Commission and National Quality Forum. Dr. O’Leary is also deputy editor of The Joint Commission Journal on Quality and Patient Safety.