Last week Doctors Council and HHC held a joint training on quality improvement in preparation for the first meeting of the Collaboration Council which was held on Friday (A post on that meeting to follow.) The training was led by the Institute for Healthcare Improvement (IHI); it was attended by both front line Doctors Council members from every HHC facility as well as clinical management from every hospital and facility and staff from the front office.
Both the training and the first meeting of the Collaboration Council marks the end of a 2 year odyssey starting with Doctors Council reimaging the role of a doctors’ union in our 2014 White Paper “Putting Patients First Through Doctor, Patient and Community Engagement: A Call to Action from Doctors Council SEIU to the Mayor and the Leadership of HHC”
The White Paper described the problem as one of physician engagement:
“In the past and currently, the frontline doctors have not had a meaningful voice in the analysis of and the solutions to the challenges faced by our patients and in quality measures and performance outcomes. Throughout the system, top-down directives and recommendations for change from outside consultants have demoralized our clinicians.”
Both the training and the Collaboration Councils are a direct acknowledgement from all sides that this problem needs to be fixed; the training and Collaboration Councils provides the framework for the solution. Not surprisingly, there was real optimism in the room.
In the first day of the training IHI presented the model for improvement in what they term the “Science of Improvement” which has two fundamental steps. First, there are the three fundamental questions that must be rigorous answered if a health institution is serious about improvement:
1. What are we trying to accomplish?
2. How will we know that a change is an improvement?
3. What changes can we make that will result in improvement?
The second part of the model is the ability to test the changes and to change the plan accordingly. This is achieved in the Plan-Do-Study-Act (PDSA) cycle.
Dr. Mike Evans provides a helpful summery of IHI’s thinking about QI in the following video.
In “The framework for Leadership for Improvement” the IHI lays out what they believe to be the central concepts of change for any health care organization- Will, Ideas and Execution. There was a strong feeling in the room that HHC had Ideas, but the will and execution needed to be improved.
Dr. Caralee Caplan-Shaw who attended to the training from Bellevue said,
“As Physicians we are all lifelong learners. But the IHI training was not about rote learning. I am coming away from these 3 days inspired and armed with practical tools I can take back to Bellevue to teach to others, energize our teams, and harness talents, and test new ways to improve care for the people and communities we serve.”
The training together with the first meeting of the Collaboration Council marks a historic week for Doctors Council. The doctors went from identifying and analyzing the problem in the White Paper, to addressing the problems through the Collaboration Councils.
While this remains just the beginning ,there is reason for hope.