In this piece, Jen Beloff, MSN, RN, APN, executive director of Quality and Safety at Brigham and Women’s Hospital, looks at how we use continuous quality improvement to identify and solve program and process challenges.
If you are working in a health care setting, you’ve undoubtedly heard of the term “Continuous Quality Improvement (CQI)” to describe the process of systematically identifying, delineating and analyzing a quality or safety problem, testing, implementing and learning from the process, and then repeating the process.
It’s a bit like the movie “Groundhog Day,” where Phil Connors, played by Bill Murray, repeatedly relives the same day, known as Groundhog Day, turning moments of monotony and at times hopelessness into opportunities for enlightenment and decisive action.
Despite being stuck in a perpetual time loop, Phil continuously learns from his daily observations and associated outcomes, and adapts his behavior and processes, sometimes leading to a different and often more positive outcome the next day.
The same can be said of introducing successful quality and safety improvement initiatives in health care. Creating a shared need and vision, gaining stakeholder support and implementing and sustaining improvement initiatives can often feel like you are waking up every morning in a perpetual time loop. This is partially because most quality and safety improvement initiatives will not be solved with one fix. Designing for continuous improvement and success means your work is never done. Some interventions simply won’t work, and that is perfectly OK.
Take, for example, Catheter-associated Urinary Tract Infection (CAUTI) prevention. In 2009, Brigham leadership and care providers formed a multidisciplinary taskforce charged with reducing the rate of infections related to urinary catheter devices. Over the last decade, the taskforce has implemented close to 50 interventions, such as back-to-basics education and the development of clinical-decision support. Some interventions were more successful than others, like eliminating yeast from the CAUTI definition and cancelling urine cultures for those patients with a negative urinalysis.
Just as Phil eventually learns to incorporate the knowledge gleaned from one day into the next, so too can quality improvement leaders. We strive to transform the monotonous and sometimes frustrating moments of quality and safety program implementation into moments of ingenuity and innovation, ultimately leading to better patient outcomes and experiences.
As I compare the 2009 and 2019 CAUTI Taskforce improvement plans, I can’t help but reflect on the fact that many of the initiatives are eerily similar. However, like Phil, I also know that tomorrow is a new day and that we will apply the lessons and successes of the past 10 years to advance the cycle of continuous quality improvement. Our CAUTI standardized infection rate at the Brigham is down 34 percent since we first started publicly reporting it in 2012 and I know through our efforts we will continue to improve.
-Jen Beloff, MSN, RN, APN, executive director, Quality and Safety
“Groundhog Day.” Directed by Harold Ramos et al., Columbia Tri Star Home Video, 2002.