Investing in clinicians' skills in applying the Model for Improvement

The ImproveCareNow Network has been focused on improving outcomes for young patients with Crohn's disease and ulcerative colitis (also called Inflammatory Bowel Disease or IBD) for more than a decade. The success of our shared work is rooted firmly in our foundation of data and healthcare quality improvement (QI) science. In 2022, we piloted a new Introduction to QI (IQI) training course for clinicians at participating ICN centers who were interested in expanding their QI knowledge and practice.

The new ICN IQI course was intentionally designed to offer clinical practitioners, with a basic understanding of QI fundamentals, a deeper dive into the Model for Improvement - the QI methodology developed by the Institute of Healthcare Improvement that forms the backbone of ICN's QI infrastructure. During the 4-part course, participants gained real-world experience using SMART aims, process maps, Key Driver Diagrams (KDD), small tests of changes through Plan-Do-Study-Act (PDSA) cycles, measurement strategies and additional improvement tools to conduct a QI project of their choice. The course was structured to provide a mix of professional QI coaching and instruction, as well as peer-to-peer support in an all teach, all learn environment.

Investing in clinicians' skills in applying the Model for Improvement to identify gaps in model IBD care and figure out what works to close those gaps and improve outcomes for kids with IBD is worthwhile. Improvement projects may differ team to team, but the goal is the same - getting kids with IBD better right now so they can go back to just being kids. 

In this round of IQI, participants tackled projects that ranged from making a small change in their EMR (electronic medical record) to automatically show them their IBD patient population so pre-visit planning and population management would be easier, to increasing MyChart signups, to creating a new med-surg IBD clinic.

Here is what some participants had to say about their IQI experience:

"I brought a simple project to the class that involved adding IBD to patients problem list in the EMR (in addition to a more specific diagnosis). The goal of the project was to give our clinic a way to automatically capture our IBD patient population in the EMR, in order to assist with pre-visit planning, population management, and identification of IBD patients for other QI projects. The project has been adopted." - IQI Participant

"The project was to increase our MyChart signups at our site from 61% to 70%. We achieved this goal and moved our goal to increase to 85% of our IBD patients signed up for MyChart. Currently, we are at 75%. Since participating, we've found that approaching patients in clinic to sign up has been more effective than cold calls." - IQI Participant

Participants in this IQI course shared that the tools and methodologies they gained hands-on experience with were assets and could help them improve IBD care and workflows at their care centers. They also acknowledged the challenge and importance of getting buy-in (from leadership and other team members) and being able to keep up with data-tracking when running concurrent QI projects.

"I do think that doing this QI class sooner would have been helpful, such as thinking about the variable to track [measures] on an ongoing basis for the run chart." - IQI Participant

"[QI Methodology has been] super helpful and have used in other IBD and GI related projects [at our care center]. In particular, use of the KDD and run charts." - IQI Participant

"Pareto charts and run charts remain a valuable asset that tell a story quickly…These tools are certainly helpful to keeping track of changes to ideas, barriers, successes, etc. behind the scenes, and highlighting weekly or monthly changes to tools as a reference point may help focus our conversations." - IQI Participant

"I have begun to see that buy-in by all stakeholders towards the overall project goals is essential to long-term success. For our GI specific work, team-members involved in conceiving and designing projects are also the ones integrating it into their own workflows, so it is fairly easy to cultivate buy-in, even if consistent adherence to the project is more difficult to achieve." - IQI Participant

Thank you to all our IQI participants for sharing feedback so we can learn and improve these course offerings! Readers, please note that some participant answers have been edited slightly for clarity.

The next ICN IQI course is already underway and participants will be working through their improvement projects over the next several months. 

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Everything we do in ImproveCareNow is magnified by the efforts of thousands of other improvers, and together we bring about a better quality of life for many. Here are some actions you can take, or invite others to take:

• Invite someone to stay #InTheLOOP with IBD stories on the ICN blog - "Sharing stories and experiences is affirming and validating. Our stories reach others and they help, which is the most wonderful part of being involved with ImproveCareNow." - Quint 

• Invite a patient (14+) to join the Patient Advisory Council - "Being part of the PAC helps me remember that I'm not alone in this journey." - Rhea 

• Invite a parent or family member of a child with IBD to join the Parent/Family Advisory Council - "I was astounded by the instant bond established with parents I had never met. Every conversation provided me with strength. It ignited another purpose in my life." - Maria

• Invite someone to download free, co-produced IBD resources - "Physical resources provide patients with actions that we can take toward bettering our quality of life, as well as our current and future care." - Quint

• Invite someone to Join Our CIRCLE - "Resources we found in CIRCLE eNews do not just focus on physical health, but also on critical areas like social-emotional needs, nutrition, back-to-school planning and mindfulness. These are valuable tools for my son to remain healthy." - Lisa