How should we approach Quality Improvement?

During the holidays, I had some time to reflect on the many benefits that come with working smarter to deliver better healthcare. Our office implemented a new EMR just in time for Christmas - perhaps not the best time to undertake such a monumental task. Having said that, one could argue that no particular time is perfect. Our office decided together that the potential quality improvement (QI) that would result out-weighed the negatives that came with such a project. Training was somewhat chaotic, as we did not know the basics of the workflow, and the vendor wanted to share capabilities that were too advanced for our learning level. So this year, in place of holiday shopping, decorating, and baking, we watched endless self-help videos on EMR implementation. 

The truly attractive aspects of our new EMR include flexibility in booking for patients; a patient portal; more timely access to test results; direct-to-pharmacy and specialist e-faxing, as well as customizable templates and macros designed to make charting easier. However, much of the data management and office tasks were downloaded on to the physicians, rather than our office staff. As with many implemented changes, unconsidered or unintended consequences cause the most grief. This has led me to consider other aspects of efficiency in our healthcare system. 

IQ and QI truly mirror one another. Physicians recognize that we need to work smarter to improve quality in our rapidly expanding, technology-driven world. The sky is the limit. Yet, this can prove difficult in practice, as many physicians have not been taught the basic tenets or the language of QI in medical school. They have rarely had the opportunity to develop the QI mindset required to evaluate our working process-es, and lead change. Many of our local Health Authority leaders and governing bodies understand the QI aspects, but by and large, lack the current hands-on clinical experience needed to implement meaningful change.  So let’s work together to find what unites us, and agree on which workflow processes improve care, and which simply pass responsibility to clinicians. Without this cooperative knowledge base, QI work just becomes more grief instead of the transformative process it is meant to be.

Doctors of BC recognizes the importance of physician leadership in change management. Physicians are a valuable and largely untapped resource in quality improvement and healthcare systems transformation. Our Joint Collaborative Committees offer a number of scholarships for training courses in leadership and quality improvement, to financially support physicians while they develop the mindset, language, and skills necessary to maximize their capabilities. Applications can be found here for:

• General Practice Services Committee Leadership (GPSC) and Development Program
• Specialist Services Committee (SSC) Physician Quality Improvement Initiative
• Shared Care Committee (SCC) Physician Leadership and Quality Improvement Training
• Specialist Services Committee (SSC) Physician Leadership and Quality Improvement Training in partnership with the Shared Care Committee. 

Funds can be applied to both the formal programs developed with the Sauder School of Business or applied to learning programs access via: the Canadian Medical Association Physician Leadership Institute; Institute for Healthcare Improvement or BC Patient and Safety Quality Council’s Physician Quality Academy. Additional training opportunities, which include both online learning and in-person workshops exist within the UBC Faculty of Medicine Faculty Development Department, and within the local Health Authorities.

With “20-20” vision, I look forward to the new year with clarity of purpose and enthusiasm. IQ leads QI. A smart approach to quality improvement, led by physicians, is how we will achieve healthcare transformation. Together, we can be the change our healthcare system needs to be sustainable and meet the needs of both patients and providers. Happy New Year.

- Dr Kathleen Ross