Welcome to this Quality Improvement for Institutions Learning Center lesson titled Engaging the Clinical Team to Develop a Quality-Centered Program. This lesson is number four of a five-lesson series authored by NCDR participant expert Sheila Nichols, who is a Clinical System Analyst, HVTI, and Strategic Operations Administrator at the Cleveland Clinic. Sheila will be sharing her expertise from an academic system perspective, NCDR participant expert Andrea Price, who is from Indiana University Health System. Andrea will be sharing her expertise from a community hospital perspective, and Michelle Hare, MSRN-LSS-GB. Lesson four focuses on engaging and expanding for process improvement. Lesson four information centers on identifying and expanding team members to undertake a process improvement initiative. To review, the core team reviewed the aligned recommendations, the gap analysis is completed, and prioritized a few projects. You are ready to begin improving the process. Sometimes a project is simple, a just-do-it, and therefore may need little committee input. A true quality improvement project requires problem solving, includes multiple decision points, and often involves complex systems. A multidisciplinary approach by a quality improvement team is preferred over individual decision makers. Quality improvement projects usually require a wide range of knowledge, perspectives, skills, and experience. If you're wondering if your project is a just-do-it or a quality improvement project, ask yourself these questions. Is the task complex? Does no one individual have sufficient knowledge to solve the problem? Is creativity necessary? Is the path to improvement unclear? Is it an efficient use of resources? Is it a cross-functional process? Is cooperation essential for implementation? The team members will be different depending on the project. Team members are usually internal, but may also contain external stakeholders. Improvement work is most successful by engaging persons working close to or in the area of the improvement work who are willing to use data. The team needed for process improvement may contain a core team member or two, but will most likely be an expanded team to be truly effective. Remember, sometimes you also need to seek out expertise outside of the organization and or those who may not work in the area, but have knowledge and expertise. Let's talk more about these type groups. The effectiveness of the quality improvement process often depends on the ability of the improvement team members to work well together. Keep your team diverse by bringing together team members from various internal and external departments. With varied skill sets, you need to be clear about what exactly success looks like and how each person's role, while different, will contribute to that success. Managing a multidisciplinary team means you need to have a good understanding of each person's role. Forming communities within the group will aid collaboration significantly. Express how it takes the whole team for the process and goals to be achieved. One is not better or more important than the other. Connect the dots on how one department depends on another and how the patient depends upon all of them for optimal outcomes. Clear roles and responsibilities facilitate effective quality improvement efforts. The following is a list of key team roles that should be determined. Team leader or chair of the meeting fully understands the processes targeted for improvement and the breadth of the project in order to effectively lead committees. Team facilitator assists the team leader in planning meetings and developing agendas. The team facilitator tends to the meeting process by ensuring the participation of all team members, monitoring the agenda, and keeping track of time. This may be the same role as the team leader. Team contributors agree to contribute their knowledge and insights to the project. They agree to support suggested improvements in their areas of the organization to facilitate buy-in for changes that result in improvement. For clinical performance improvement work, having a provider champion on the team is important. When using registry data, consider using the registry RSM and coordinator to share the data. The champion should understand the data to facilitate performance change in the measures. Communication disseminator, who will be responsible for capturing the meeting minutes and follow-up items. These roles may be used to develop a project or team charter for increased transparency. Depending on the available human resources and skill sets, some persons may have multiple responsibilities. An effective improvement team is flexible enough to respond to the ongoing challenges of quality improvement work. Now is the time to engage with the broader multidisciplinary team. The team's constituency will be dependent on the project for improvement. Based on the information gained in the final gap analysis, present what is the area for improvement, who should be involved, how much time do you have to complete it. Begin with what the issue is. What does the data show and why do we care? Quality improvement impact on clinical care and process efficiencies. Create the why. Educating the clinical team on definitions and documentation. Educating program and key clinical team members on reimbursement impact and reputation scores. Communication with other audiences, ancillary departments, external stakeholders, etc. Finally, determine how and when the results need reported back to the core team for review. Andrea Price shares best practice from a community hospital in the Indiana University Health System. As the Chest Pain MI Registry was launched at a community hospital, there was a conscious focus to look at performance awards shared in the public domain. These measures are reflective of the total AMI care, expanding beyond STEMI care. In the first quarter of participation, a common theme was discovered to ensure cardiac rehab referrals were a quality improvement area. Without much delay, a process improvement team was created with representation from the emergency department, cath lab, nursing, cardiac rehab, pharmacy, and the practices. This team was pulled together with the goal to understand the opportunities for cardiac rehab referrals. The team leader or process improvement chair used the expertise of the Chest Pain MI Registry coordinator to help comprehensively detail the issue at hand or current state, review available registry and publicly reported data. Ultimately, changes were made to the cardiac rehab form, which also served as the cardiac rehab order assuring referrals were not lost. After changes were incorporated and improvements gained, the team went on to undergo a second phase of the process improvement initiative or PDSA cycle to increase cardiac rehab referrals from the medically managed and STEMI patients. Sheila Nichols shares her expertise as a clinical system analyst, HVTI, and strategic operations administrator at the Cleveland Clinic. In this academic best practice, I will share a couple examples. In the EP device implant registry, device-based therapy guideline improvements generally surround an understanding about required documentation and getting the documentation itself. The abstractor and quality team presented to the physician champion. A process improvement team was created, which included the abstractor, quality facilitator, quality manager, mid-level providers, fellows, physicians, ITD. A collaborative approach ensued, which resulted in IT building the data elements needed into a template, which had hard stops if required documentation was not populated. This became part of the provider's workflow rather than another task. For the TBT registry, in order to receive three-year risk-adjusted mortality metrics, the KCCQ questionnaire and five-meter walk test must have greater than 90% completion, and the site was falling short. This improvement team had even more boots on the ground staff than the others and consisted of nurses in the outpatient clinic, nurse manager, medical assistants, abstractors, and the quality manager. The improvement process consisted of understanding inclusion criteria, educating clinical staff, collaborating and developing a process. The result of this collaboration was that abstractors get KCCQ questionnaire and nurses get the five-meter walk, which assured we would capture greater than 90% compliance to get three-year risk-adjusted results. This concludes Lesson 4 of 5, Engaging the Clinical Team to Develop a Quality-Centered Program, Engaging and Expanding for Process Improvement. Thank you for your participation.

Engaging the Clinical Team

Quality-Centered Program

Multidisciplinary Approach

Process Improvement

Team Roles