In a session with incredibly exciting content, a trio of presenters representing Children's Medical Center Dallas, The Children's Hospital in Aurora, CO, and Nationwide Children's Hospital in Columbus, OH, shared outcomes from a group that was brought together to look at how to integrate quality improvement as a central element of children's hospitals' relationship with medical schools.
There is a need for an integrated quality program in children's hospitals. Significant investment is being made to improve quality and safety of care. Yet there are still significant gaps in quality and safety outcomes in the care of pediatric patients in these same institutions. If so much effort is going into improvement, why are there still so many problems?
The approach of the presenting team was to recognize the lack of integration between the hospitals and the medical schools they work with and look for ways to bring the two into alignment. The two do not always integrate improvement strategies, priorities and resources. There is a lack of standardized approach to quality imrpovement education. And hospital improvement efforts can fail to consistently engage physicians who do not in turn see personal recognition for their work.
In 2009, executives and academic chairs from 15 NACHRI member children’s hospitals met to discuss the benefits and challenges of integrating their respective quality programs and to define implementable approaches for integration. A three-part integration framework was developed for adoption and testing at the participating institutions and dissemination to other children’s hospitals:
- Alignment, Prioritization, and Funding
- Quality/Performance Improvement Education
- Professional Development and Career Progression
The group found common ground and realistic approaches to integrating quality programs for improved patient outcomes and expanded quality improvement expertise. Some of the key steps toward alignment:
- Commtment starts with board of directors, medical board and medical staff leadership
- You need a defined position in the academic department with quality as a responsibility to help facilitat integration Physician participation is crucial. There is a tension between add-on commitments vs. a true dedication of time.
- To get physicians engaged and committed, there must be a tie to professional development for physicians for it to be worth their time. As with traditional clinical research areas, training physicians works best with mentors. These mentors may be sporadic within the institution, but it is possible to get external mentors to help team quality improvement strategies to physicians.
- It is not just the inside that needs change. Professional societies need to promote and recognize the legitimacy -- and urgency -- of quality improvement and safety work. Funding from government, foundations and other grantors needs to be directed to QI and safety work.
Long-term objectives of the work. The goal of this group is that participating organizations will use the integration framework as the basis for dialogue, planning and devleopment of an integrated quality program at their own institutions. A white paper has been submitted for publication, so the presenters are not permitted to post their slides on the NACHRI website until after publication of the piece. However, the group is excited about sharing their work in detail in the near future. The group plans for dissemination of the integration framework to a wider pediatric community. This is a beginning and a call to action.
For more information on the presenters and their work, the session description is available on the NACHRI Annual Leadership Conference website.
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