Highlighting Quality Improvement in Toronto

By Craig Olmstead, Medical Student, University of Toronto

It was a long, but satisfying day.

From the early-morning set up to the take down in the evening, the 2^nd annual Quality Improvement & Patient Safety (QuIPS) Conference, presented by the Institute for Healthcare Improvement’s University of Toronto Chapter, provided ample opportunity to discover the breadth of health care system innovations occurring in Toronto and beyond.

Held May 5 at the University of Toronto, the conference drew about 140 delegates from across universities in the greater Toronto area. Presentations from professionals and students alike highlighted the many initiatives being undertaken to improve health care delivery throughout Ontario, from developments in e-Health, to mobile phone applications for children with diabetes, to improvements in hand washing compliance.

Most gratifying, however, was seeing the projects done by the many students present, displayed for the whole conference to see. I was incredibly proud that the work my team had done was one of these projects. Over the better part of the last academic year, five students from various health care-related backgrounds, including myself, have been engaged in a quality improvement project at one of the major hospitals in downtown Toronto. We had the chance to work on a program to improve physician adherence to well-established guidelines on the prevention of serious blood clot formation in the legs of non-mobile patients. We had an opportunity to see how frequently physicians were considering this risk, and to initiate interventions in one department aimed at improving the rates of risk assessment. While results are still preliminary, it does appear as though there was an improvement after these interventions.

After months of dedication demonstrated by my teammates and our in-hospital support, it was very rewarding to not only have our poster be viewed by so many influential individuals. (Having our efforts recognized by being voted 2^nd in the conference poster competition was simply icing on the cake.) It was a fitting culmination to over half a year of hard work overcoming challenges to make improvements to the health care system in our community.

The QuIPS conference was an excellent venue to share our story and learn from others, and I can express nothing but appreciation for being given the chance to do so.

Chapter Corner: Three Questions to Consider When Planning Quality Improvement Projects

Quality improvement projects benefit both students and organizations in a number of ways. Students have the opportunity to network and develop their improvement skills. Organizations, meanwhile, have the opportunity to meet enthusiastic students dedicated to improving healthcare, develop fresh ideas with student contributions, and guide and mentor the next generation of health professionals.

We just had our fall information session last week, and students have begun sending in their project applications. This is the first year the Atlanta chapter of the IHI Open School has embarked on establishing quality improvement opportunities for students.

Our goal is for students to gain real-world experience by participating in improvement projects, whether it is a snapshot or the various phases of a project. In addition to skills in quality improvement, some of these projects will also allow students to develop skills in patient safety, teamwork, leadership and patient-centered care.

Finding projects
Our group focused heavily on recruitment to gauge student project interest while simultaneously searching for project opportunities at various organizations. We wanted to ensure that there would be enough student interest to participate, but also wanted to ensure that project opportunities existed for student volunteers. I used contacts from informational interviews, previous internships, and professors to ask if their organizations might be interested in having students volunteer their time to quality improvement projects. If these contacts expressed interest, we then discussed the potential projects over a phone call.

Here are a few of the questions we kept in mind during the project planning process:

1. How can we develop and maintain good relationships with participating organizations?
If we maintain good relationships with these organizations, we might find additional project opportunities in the future within and outside of the organization. To maintain these relationships, we plan on touching base with project supervisors every so often throughout the project. And since this is our first year, we have limited the number of IHI Open School projects so we can focus on successful completion of these few projects.

2. What if we get a smaller applicant pool than we expect?
We wanted enough student interest so that each project would be able to find a number of students from various disciplines that would be a good fit for the organization. We emailed faculty/department advisors and our student government association to forward on our IHI Open School information to students. And since medical students are difficult to recruit due to their incredibly busy schedules, we contacted dual degree MD/MPH students that are in their MPH year, where the schedule is more flexible. Our final applicant pool is still yet to be seen.

3. How can we encourage students to share experience and knowledge with other students? While we want students to develop various skills, we also want them to share their project work and knowledge with other fellow students. We hope that this will create a culture of teaching others, developing leaders, and building relationships. We'll be setting up Open School meetings for students to share what they've learned.

It will be interesting to see how these projects progress over the course of the year. If anyone has any comments or suggestions, we would love to hear them!

- Becky Ng, Public Health student, Emory University

Chapter Corner: The Importance of Sharing Knowledge

By itself, content is limiting. While the information from a book is useful, there is no incentive or opportunity to offer an opinion and receive a response. It is simply a one-way flow of information. It's the people we meet and speak to that hold the real knowledge. As social creatures, others' work and life experiences will resonate more with us when we ask questions and have the opportunity to respond directly, whether it is in person or through email. I know all of these things because I learned them firsthand.

I asked a colleague of mine if they knew anyone working with process improvement in healthcare, and they put me in contact with two professors at Emory University's School of Medicine. From these connections, I was put in touch with a director at a nearby hospital's center for clinical performance improvement, as well as the Chief Quality Officers at two other hospitals. I've learned a tremendous amount from my conversations with them.

My conversations with these people were the true driving force that sparked my interest in quality improvement in healthcare, and I try to drop a line to say "hi" every few weeks or months. I'm even working with the director at the clinical performance improvement center to establish a quality improvement project for the Atlanta IHI Open School students. It's experiences like these where I find value in establishing new relationships, especially with those so willing to give back to students.

Here are some other ideas on sharing knowledge:

• Take advantage of others' knowledge by talking to fellow students, teachers, leaders - anyone you can make time for (and can make time for you).
  
• Search on LinkedIn for professionals in the area who are involved in healthcare improvement (after all, wasn't LinkedIn made for networking?).
  
• Email leaders from other schools in your region, or across the country. See what others are doing and network to share ideas.
  
• Read the "Chapter Accomplishments" on the IHI Open School website and find ideas that interest you and your group.
  
• Contact schools to learn more about their methodologies and challenges to accomplishing their goals. (It's been my group's experience that IHI Open School chapter leaders are extremely receptive to sharing ideas.)
  
• Talk to others to share knowledge and to generate opportunities. People generally love to talk about themselves, and would be more than happy to meet or speak about their experiences (probably more willing to do so than you might think).
  
• Talk to professors and coworkers, and ask them about what they do and how they got there. Ask if they know others in quality or process improvement, and see if you could set up a time to chat with them for 15 minutes. This could lead to new partnerships with your chapter, quality improvement projects, mentorships, additional IHI Open School exposure, among other advantages. Once you've developed those relationships, maintain them by following up throughout the year.

I reached out to one of my public health professors to ask about her work in quality improvement and told her about my involvement with the IHI Open School. After some meetings and phone calls, we eventually established two quality and process improvement team projects for IHI students to be involved in, and we hope to find the right students to make these initiatives a success! It's my hope that I'll be able to give back the same way that these professionals did for me.

I've found it invaluable to have these discussions with others, and I encourage other chapters to do the same. It sounds simple, but it can be tough work to find and maintain these relationships. We will always have something new to learn from each other.

- Becky Ng, Public Health student, Emory University

Chapter Corner: Happy Hour in Atlanta!

This is the newest installment in a series of posts written by chapter leaders and members. The goal, simply, is to share best practices and creative ideas with other chapters around the globe.

I love happy hours. But I love them even more when they are an excuse to spread the word about the IHI Open School.

My group, the Atlanta IHI Open School Chapter, is made up of students from Emory University and the Georgia Institute of Technology. We kicked off recruitment for 2011 on July 7th with an IHI Open School information session. We followed this up with a happy hour the following Saturday.

Why did we do a happy hour? We think social events like these build solidarity between group members from different schools. These are opportunities for our current and prospective members to meet other students outside of our particular programs. Events like the happy hour will help develop friendships and create an added incentive to participate in IHI Open School activities throughout the school year. We had a turnout of about 10 at our happy hour session, despite the pouring rain. The vice president of Health Students Taking Action Together (HealthSTAT) was also in attendance, and she and our president have discussed plans of co-sponsoring events throughout the year.

Even better, our summer information session turnout was great with over 20 attendees, including a handful of healthcare professionals. At our meeting we included snacks and distributed a fact sheet that summarized the IHI Open School, our goals for the year, and proposed upcoming events.

Here are three questions - and answers - we think might be helpful for other Chapters:

What did we include in our information session agenda?
1. A Denver Health patient safety video
2. Introductions around the room
3. Small groups to briefly share any personal stories of patient harm or unjust culture
4. A short presentation made by our chapter president describing what IHI is, the Open School, and what we've done so far
5. An overview of what we have planned for the year, including:
- Monthly "lunch and learns"
- IHI modules to be integrated into school curriculum
- Upcoming quality improvement projects
6. Don Berwick's Introduction to Open School video
7. A survey asking about interest in events and involvement

Why start recruitment in the summer?
We want students to start thinking about the IHI Open School and talk to their friends about it. We feel the interest-we just have to get the word out! We also want students to start preparing for any quality projects they might be interested in by taking the IHI quality modules as early as possible to prepare.

How did we advertise our event?
We asked our schools and departments to forward our event email and flyer to the current and incoming class, as well as posted flyers around schools. We also emailed any connections we had with faculty and professionals to pass on the word to any interested individuals.

We're trying to foster a supportive environment where we can build relationships and share ideas. Social events like the happy hour can help facilitate this, in addition to our group meetings and learning events. What are your thoughts?

- Becky Ng, Public Health student, Emory University

Chapter Corner: Five Rules of (Student) Engagement

This is the first in a new series of posts written by chapter leaders. The goal, simply, is to share best practices and creative ideas with other chapters around the globe.

One of the biggest challenges that we face as a group at UMass (in Worcester, MA) is encouraging people to come to our events and classes. The topics and the speakers may be fantastic, but the audience consists of only about 10 students. It is difficult to engage students in anything outside of the board exams even if the material will be important in their careers. We worked hard to increase student interest and attendance at events this past year. Things did not always work out for us, but the following are some of the strategies that we used to bring students in:

1. Make it personal for the students. Take a story that will really hit home and organize a speaker or a class around that one story. For example, we had a death at UMass Medical Center on the telemetry floor. The story was all over the local news broadcasts and many students were discussing the case, especially saying that they were embarrassed to represent UMass. We took a different spin and invited the physician who was working to solve the problem to come and speak. He talked about what UMass was doing to prevent future incidents of alert fatigue and really excited the students to get involved in solving the problems instead of gossiping about them.

2. Early preparation is critical! We had one event that had great speakers and a really interesting topic, but we had the worst luck getting a room. The day before the event a room finally opens up, and we emailed out to all of the students with the room assignment. The morning of the event room reservations calls us and switches the room. So we email again saying, "Last minute room change!!" Later that day, mere hours before our event, we get switched to yet another room. So we send out another room change email, but at this point, it is just about time to get started. In the end, we had fewer than 10 students in attendance. Lesson learned? Get all your ducks in a line quickly and early so you can accurately advertise long before the event.

3. Get creative with your advertising. This example doesn't come from our IHI Chapter, but one of the global health groups on campus sponsored an HIV/AIDS awareness event. To advertise, they gave out small goodie bags in class. These contained two condoms and enough M+M candies to represent a day's worth of antiretroviral medications. They also included a short written piece with some facts about HIV and an invitation to their event. Even if people didn't attend the event, they were exposed to the problem and the ideas they were promoting.

4. Bring in the big guns! Include professors and administrators in the planning, and definitely send them an invitation. It adds legitimacy to events that you are organizing. We ran a panel event on interprofessional communication, and we had the dean of the school of nursing in attendance. She really encouraged nursing students to attend. We had great turnout from the school of nursing, especially relative to medical and graduate students.

5. Schedule informal events around your class breaks. We started a series of "lunch and learn" events during the lunch breaks in our class schedules. These were short events, usually about 45 minutes, where students would pack a lunch and we would lead a discussion of a case study or recent article. The Open School web resources are fantastic for this sort of forum and attendance was good because people were sitting around campus anyways.

These were some of the strategies that really helped us this year, but we still have a long way to go in engaging students in QI and patient safety. Sadly free food tends to be the best motivator, and we just don't have the budget to feed hungry grad students with every event.

What have other people done at their chapters?

- Aubrey Samost, medical student, University of Massachusetts