Quality Improvement(QI) is the systematic and continuous action that leads to measurable improvements in health care services.  A number of residents in their 2nd year and beyond may choose to do a QI project for their scholarly activity.  By this time residents have become familiar with their environment and may have had time to come up with ideas on how they could change some factors in order to provide better patient care.  Regardless of the project, QI is all about ultimately improving patient care.  This may be by making processes more efficient, addressing safety issues, or even improving patient flow through the hospital.  

To complete a QI project you will need a faculty mentor who can guide you through the process.  Ideally, the project would be backed by the resources of the sponsoring department.  However, QI projects are rarely department based and will usually require buy-in from a number of other health professionals.  

For faculty, QI can be used to obtain MOC IV credit.  Please contact the Office of Continuing Education at MOC@uams.edu or check out the webpages to get more information.

1. Identify the Problem
   1. What could be improved in your department, the hospital wards, etc.
   2. Do you have data that you can use and/or collect for before and after an intervention?
2. Obtain an IRB determination
   1. Refer to the IRB section of this guide for more information
3. Begin the DMAIC Process

The DMAIC Process is a commonly used framework for QI and the one we will be looking at for this guide.  

1. Define - Define the Problem
   1. Develop a Project Charter with a problem statement, SMART goals and objectives, scope of the project, team list with roles and responsibilities, business case for project, action items, deliverables, and due dates. - DMAIC Worksheet
      1. Problem Statement - describes the concern, provides when and where the problem occurs. provides measures of the magnitude of the problem, consequences of the problem.
      2. SMART - Specific, Measurable, Agreed to, Realistic, Time Specific
2. Measure - Quantify the Problem
   1. Develop key driver diagram and measurement plan, collect baseline data, identify high impact areas - Key Driver Diagram
3. Analyze - Identify the Cause
   1. Develop a process map, Conduct team brainstorming and "5 Whys" analysis, develop cause and effect diagram, and how to test for causes.
      1. 5 Why's - Ask "Why did this happen" and keep asking Why until you have determined the cause.
4. Improve - Implement and Verify a Solution
   1. Remember standardization, documentation, measurement, training, and resourcing.
   2. Remember to manage the social aspects of change - give people who are involved some control.
5. Control - Maintain the Solution
   1. Develop a plan to spread the solution - team needed, order of spreading, infrastructure and resources needed.

      ---

Based on a PowerPoint by Dr. Wendy Ward, Dr. Michael Morris, and Doreen Tooch.

The Quality Improvement in Advanced Learners Program (QIALP) is a 9-month QI program designed to train advanced learners (i.e. residents and fellows in medical school, clinical pharmacy, psychology, or other advanced learners in health care professional fields) to work effectively on interprofessional quality improvement project teams (each with two faculty facilitators) while using quality improvement science methodology. By the end of the course participants should:

1. Be able to discuss basic improvement science concepts.
2. Have completed an improvement project that addresses one or more of the Quadruple Aim UAMS institutional objectives (improving patient care/patient experience, reducing costs of care, improving population health, and/or maximizing professional wellness/work satisfaction while reducing burnout).
3. Be comfortable participating in additional quality improvement projects.

This interprofessional education program will be conducted as part of the Office of Interprofessional Education (OIPE)’s efforts to build collaboration skills across the three missions:  research, clinical care, and training. To learn more contact the Office of Interprofessional Education at IPE@uams.edu or (501)-686-5686.

QI Resources Toolkit from Interprofessional Education