IHI Announces Winner of David Calkins Memorial Scholarship

Chi Chu, a second year medical student at UMass Medical School, won this year's David Calkins Memorial Scholarship, good for a free seat at the National Forum and up to $1,000 for travel, lodging, and expenses.

Here is his winning esssay:

For years, St. Anne’s free clinic has opened every Tuesday evening to provide free medical care to communities in and around Worcester, Massachusetts. St. Anne’s is the busiest free clinic in the area, often seeing over 80 patients in one night. Frequently, searching for medications is the most time consuming step in patient care. Because medications are almost all donations, they are notoriously difficult to track, and there is little in the way of record keeping for what comes in. Thus, searching for medications that may not be in stock takes up a significant amount of time per patient, forcing them to wait and occupying a volunteer who could be caring for others.

I am working on a process improvement project to eliminate waste in the medication management process using Lean methodologies. The goal is to decrease the total time spent managing drugs by 50% in 3 months. This includes time spent logging the incoming donated medications, searching for medications, and counting medications to dispense to patients.

Currently, I am collaborating with the clinic coordinators and volunteer “regulars.” These are the people who are most familiar with the clinic’s processes, and who show other volunteers what to do when they come for the first time. Therefore, they are in a prime position to help map out current state processes and implement tests of change.

The primary outcome measures include average time spent logging donations, searching for medications, and dispensing medications. We also plan to track volunteer ratings of the ease of finding and dispensing drugs. These balancing measures will check that changes are not making the process too complicated, which is particularly important given the week-to-week turnover of most volunteers.

So far, the medications have been sorted into bins according to the class of each medication. We have also nearly finished entering the in-stock medication quantities into an electronic spreadsheet. Because the medications are shared with other local free clinics, we are collaborating with coordinators of the other clinics to keep the spreadsheet updated. This real-time inventory will help drive decisions going forward.

Our focus is on designing an efficient, robust, and sustainable process for determining if we have a certain medication, finding it, and then dispensing the correct amount. Change ideas we are considering include prepackaging commonly dispensed quantities of certain drugs (which would reduce patient waiting time and avoid recounting) and using visual management principles (to allow easier identification of drugs that need restocking). In short, we have many ideas – we now need to put them to trial. We plan to pilot small tests of change, targeting the most frequently dispensed medications according to our data. In this manner, we hope to get actionable feedback each week regarding what worked and what did not, such that we can determine how to proceed in the next week. Ultimately, we hope to instill a culture of continuous quality improvement that persists through changes in leadership, allowing St. Anne’s to provide ever better care for all future patients.

Editor's note: Click here for more on the David Calkins Memorial Scholarship.

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