In 2020, an AAP quality improvement measure helped a team of pediatric residents decrease the emergency department boarding times by 10% to meet national standards. Quality improvement (QI) programs may be statewide and led by large teams or practice-level and led by a single person, but thankfully size and scope is no indication of the benefits QI measures can provide for patients. These scientific programs can improve patient care, efficiency, communication, and more. Here’s how to get started with a practice-level QI initiative, from identifying gaps, building a PDSA cycle, reviewing data, and measuring your QI’s success.
Small Scale QI Projects: Getting Started
Over their careers, independent pediatricians may choose to participate in large scale QI projects, such as this asthma learning collaborative across several states, as well as measures focused on their own private practice, such as improving patient recall. While both large scale and small scale are important tools to improve health outcomes, this post will focus on QI initiatives for individual practices or independent group practices.
QI projects at an independent practice will likely involve more hands-on planning, research, and implementation than a larger scale project. Whether you’re working with a team of two or twenty, with a pediatric resident or a group of partners, a great QI initiative begins with a strong team that communicates well and has a project champion or cheerleader who takes on the project and commits to moving its parts and people towards your established goals.
You’ll also need to know the basics of a QI initiative: you can complete the EQIPP: QI Basics 101 course individually or in a group. EQIPP is a division of the AAP, and as they are accredited by the Accreditation Council for Continuing Medical Education (ACCME), you can receive CME for this module.
In the following sections, we’ll briefly outline the steps for a successful QI program, as described by the AAP in this resource guide.
You can identify opportunities for quality improvement across your practice. Whether you want to submit more clean claims, improve employee retention, or simply meet your patient recall goals for the year, the options for QI are almost endless.
A great QI goal will fit into the Plan, Do, Study, Act cycle. In the Plan phase, the QI team should identify a goal that is measurable, what outcomes will mark improvement towards their goal, and the actions that will achieve the desired outcomes. The AAP suggests that a practice new to QI initiatives can attempt a simple initiative for their first project “for a greater likelihood of measurable improvement and to generate enthusiasm among staff.”
You might also select an area where your practice is not performing as well as desired. For example, if you want to improve the rate of maternal depression screenings, a QI initiative might introduce workflows that prompt a provider to schedule a screening during a newborn visit. The measurable outcomes would become the number of screens scheduled, and workflow reminders the catalyst that helps providers take action towards their goal.
2. Put your plan into action
When beginning your QI initiative, it can be useful to test a small sample before embarking on the complete project. Continuing with the example of maternal depression screenings, you might test one provider/patient scenario on a single given day and note whether the results you expect occur.
There may be obstacles you didn’t foresee, such as parents being distracted by their newborn or reluctant to make another appointment. In this case, your team can return to the planning stage -- maybe your moms would respond better to a maternal screening during their child’s appointment, during a telehealth visit, or without their child present. If an initiative does well with a sample population, you can proceed with the full project while preparing for the next steps.
3. Study your wins and losses
The data you’ve collected over your project’s lifetime will help you understand where it succeeded and areas where it could be improved. The AAP recommends meeting at regular intervals, but for a small project lasting a short time, it might be logistically more useful to study data at the end of your project’s timeline.
Your QI team’s data will help you determine what steps your practice can take to improve your initiative moving forward. After you’ve collected your team’s analyses, this is also a great place for a practice to take the pulse of your other colleagues and employees. How do they feel about the project? Was it stressful or confusing, or did they enjoy the project but have suggestions for improvement? Gaining objective views from outside your QI initiative can be helpful in not only improving the project overall, but also making sure the initiative fits well within your practice’s culture and the scope of your team’s abilities.
4. Act and improve
Depending on your QI project, the “Act” stage of your PDSA cycle is where you’ll take everything you’ve learned and put them into practice, or else begin to identify the obstacles and barriers that could be addressed in subsequent PDSA cycles.
For example, perhaps you’ve found that maternal depression screenings went up during your project, but now that you’ve got this data, you now know two things: first, that your current workflows could be designed to better suit mothers who want access to telehealth for themselves and their infant, and second, that many of your newborn patients’ parents are seeking lactation support. The first discovery can help you improve the current QI project in subsequent iterations. The second discovery could lead to a second QI project, perhaps led in tandem with the first or led by a separate team, if your practice’s resources allow.
Implementing Bright Futures Guidelines
The AAP’s Bright Futures Guidelines suggest that QI initiatives are a great way to implement some of the guidelines and achieve some of the outcomes and goals listed of disease prevention, health promotion, and more.
If your practice has a goal to implement more Bright Futures guidelines, this tip sheet could be a great place to start and begin your practice’s planning phase. You could choose to focus on early childhood populations, middle childhood and adolescent populations, or both groups together to improve office-based practices, such as patient recall and identifying children with special healthcare needs.
Other tools you might find useful for beginning your practice’s QI process include QI Resources from the AAP with suggestions for clinical practice, QI Office System Tools from Bright Futures with tip sheets and groups to contact for assistance in specific QI projects, such as the Council on Children with Disabilities’s toolkit.
The Quality Improvement Innovation Network (QuIIN) is a network within the AAP that is open to all AAP members. This network can serve as a resource for your practice or as a collaborative tool in larger QI projects. If you’re looking to begin a QI project to earn Maintenance of Certification (MoC) credits, you might find assistance from the groups listed here from Bright Futures.
If you’re a PCC client, you can also utilize any of the tools and services PCC offers to help you in your QI project, from tracking your clinical measures on your Dashboard, creating a custom report with the help of your Client Advocate, or analyzing areas for improvement with our Pediatric Solutions team. Explore how your EHR can help you by checking out the examples we provide for PCMH quality measures here.
One way to identify good opportunities for a Quality Improvement project is by exploring the options you have to increase revenue, one simple measure at a time. Learn about 7 services that could help make your QI project a success with this webinar by PCC’s Jan Blanchard.