By Kathryn Young

Hospital staff have great ideas for changes that will improve patient safety, but turning those ideas into reality can be daunting. Where do you start?

That’s how Jonathan MacLeod, Andrée Vincent and Lynn Kachuik – from The Ottawa Hospital – felt before they discovered the training, tools, tips and support from the hospital’s Quality Improvement (QI) team that has helped launch their projects faster and with more success.

“When I walked in I didn’t know where I was going to start with this process,” says MacLeod, Manager of Safety and Prevention. His project will improve the violence risk assessment by incorporating better quantitative and staff survey data earlier in the process. “By ensuring we’re implementing recommendations sooner, we’re creating a safer environment for staff and patients, the patients around them (such as roommates) and their family members.”

Likewise, Kachuik is also leading a patient safety project: pilot-testing a discharge checklist to be used throughout the hospital for palliative patients for end-of-life care. Even though she’s a veteran of QI and research projects, she found the training helped her team clarify its goals and objectives, and quickly identify any key missing pieces.

“It’s forcing us to take a step back and look at all the pieces, the order, how to simplify the checklist and make it easier for other teams to use,” says Kachuik, Advanced Practice Nurse in Supportive and Palliative Care. “They’re very vulnerable patients who require a lot of supports and access to services in the community. If the services aren’t quickly accessible and set up when they go home, they’re going to end up back in our Emergency Department. Safe discharges mean everything is there to keep the patient safe.”

The QI team launched two training courses earlier this year – a one-day introductory course and a four-day program to take staff through a structured step-by-step improvement framework so they can successfully design and lead QI projects. Trainees learn how to:

• Effectively write their problem statement.
• Understand their role.
• Learn why local fixes are not always best.
• Apply various quality improvement tools, handpicked from the best methodologies, such as project charters, measurement plans, audit tools, process maps and more.
• Identify outcome, process and balancing measures.
• Develop effective plan-do-study-act cycles.
• Make the improvements stick.

The QI team took the best from various other programs (such as LEAN, Six Sigma and the Institute for Healthcare Improvement model) and combined them into one simple, five-step how-to framework. The team offers an applied, just-in-time training program geared to this unique Ottawa Hospital approach.

“By the end of the first morning, I felt better,” says MacLeod, who took the four-day course. “The tools and framework they provide help you assess your current state and identify your problem and places for improvement. It doesn’t take long to get focused and get started.”

“Identifying the problem can be daunting because you don’t know where to begin, but when you use these tools you know exactly where you’re going at all times,” said Andrée Vincent, Quality Lead for employee scheduling services in Human Resources. She had led QI projects before, but found this time was much easier.

“The steps are there, the tools are there and the team is there to help,” said Vincent. “They gave us tons and tons of tips on how to measure data, how to get information from your stakeholders, techniques to help us really analyze what the issues were and give us a baseline so we could look in the future to see what the improvements were.” Her favourite tool was the swimlanes diagram for process mapping, which helps identify all the people who need to be involved in the solution.

Kachuik said it’s important for a whole project team to do the training together.

“It gives you a common language,” she says. “It’s clear and logical and you have something to guide you. It provides the rationale for why you need to do certain things, and keeps you on the straight and narrow instead of going off on tangents.”

The Ottawa Hospital earned ‘exemplary’ status from Accreditation Canada last spring, in large part because of its commitment to continuous quality improvement, which in turn improves patient safety – an essential component of quality health care.

“Quality isn’t something we should recognize only for one month during the year,” said Samantha Hamilton, Director of Quality and Patient Safety. “Continuous improvement is, in fact, the core of what quality means.”

In that vein, the QI team is doing QI on its own courses, using feedback from trainees to make the courses even better.

“You’re spending four days in this program but the value and return on the time you spend – you can’t quantify it,” says MacLeod.

Kathryn Young is Publications Officer, Editor-in-Chief of the Journal at the Ottawa Hospital Research Institute.