ProjectConnect: A Quality Improvement Project for … Quality Improvement Projects

The Tulane University IHI Open School Chapter, the first one in Louisiana, was founded in December 2010. In just one year, we've seen our membership grow to more than 70 members that have initiated multiple quality improvement projects at Tulane Medical Center.

Organizing all of those projects, ironically, turned into a quality improvement project itself.

Let’s first step back a bit. We started holding monthly meetings in early 2011, open to medical students and faculty, to discuss quality improvement related topics in health care, many of which were based on modules available on the IHI Open School website. After speaking with many students and faculty who attended those initial gatherings, we began to understand that our medical community was full of enthusiastic faculty and students who wanted to get involved with quality improvement at Tulane. However, we didn't really know how to get started connecting everyone with this shared interest and enthusiasm. We made solving this problem our main goal.

We decided that the most effective quality improvement project would be to connect the like-minded individuals in our medical community and enable them to actually do quality improvement. This is how we came up with ProjectConnect, an online quality improvement project repository and social network. We designed ProjectConnect with three goals in mind:

1. Provide a secure online platform to create, share, and manage quality improvement (QI) projects. 2. Facilitate collaboration and mentorship between Tulane faculty and medical students on QI projects. 3. Promote QI and patient safety awareness within the Tulane community.

After two months of internal meetings and guidance from our faculty advisor, Dr. Frank Rosinia, we submitted a formal business proposal to our dean's office, made a formal presentation, and secured funding for the development of ProjectConnect. We spent the next five months developing and testing the application. For example, we made sure students and faculty could log-in with their existing emails and that project data was visible to everyone after it was entered. Meanwhile, we continued holding Chapter meetings every six to eight weeks to build our chapter membership.

In August 2011, we held a faculty breakfast to unveil ProjectConnect. We asked the faculty – from Tulane Hospital, the medical school and the school of public health – to bring their laptops to breakfast so we could teach them how to log-in and enter projects into the system. (Gaining faculty support was crucial to our effort.)

Once we had some QI projects loaded, we scheduled a meeting to introduce ProjectConnect to our medical student community. The student response has been tremendous, and today there are more than 20 QI projects in the system in various stages of completion. A few examples of the work that’s going on:

• Improving patient handoff efficiency
• Reintroducing a surgical safety checklist in the ORs at Tulane
• Decreasing CLABSI rates
• Developing an effective method to train first- and second-year medical students in clinical documentation

Our Chapter continues to grow and the incoming student leadership has big ideas for developing a QI elective based on IHI Open School modules, with the goal of incorporating it into our medical school curriculum in 2012.

- Clinton Piper, medical student, Tulane University

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.