- Email: [email protected]
Building a Community of Practice for Quality
QUALITY MATTERS
PAUL NAGY, PhD
Building a Community of Practice for Quality James S. Meyer, MD, Paul Nagy, PhD A regularly scheduled meeting or conference is a straightforward and effective activity to help build a culture of quality in your department. This gathering should bring together interested parties across the spectrum of radiology care delivery and include radiologists, technologists, nurses, clerical staff members, and administration. The diverse nature of the group will provide a holistic perspective to understanding system processes that invariably cross boundaries of responsibility. This forum can help fulfill radiologists’ ABR Practice Quality Improvement Maintenance of Certification requirements [1] and residents’ ACGME IV systems-based practice requirements [2] and can assist in departmental preparations for a Joint Commission visit [3]. More important, a successful meeting can provide a valuable open channel of communication within a department and act as both an early warning system concerning systemic failures and an important bridge to maintaining healthy relations between the hospital staff and the physician practice. Another important purpose is to narrow the authority power distance and acknowledge the equal roles of the all department members in patient safety. In July 2005, a quality and patient safety meeting was initiated in the Department of Radiology at the Children’s Hospital of Philadelphia. The primary goal of this 1-hour monthly multidisciplinary conference was to promote an open and nonpunitive departmental culture of quality improvement (QI). Continuing medical education credit for physicians attending the conference was arranged to enhance attendance and help satisfy the Pennsylvania State 808
Board of Medicine’s biennial requirement for physicians for 12 hours of continuing medical education in patient safety or risk management (http://www.dos.state.pa.us/med). A light breakfast was provided. Each conference began with a “patient safety moment,” in which a patient safety activity was discussed and concluded with the review of an anonymous “missed” case. Other agenda items included an educational component as well as QI and quality assurance (QA) departmental initiative updates. Early on, the educational component constituted a significant portion of the conference, focusing on definitions and methods specific to the area of QI, Joint Commission regulations and activities (eg, National Patient Safety Goals), and departmental and hospital policies and initiatives. The number and types of departmental QI and QA initiatives grew, often as the result of discussions that had occurred at the conference. As the number of QI and QA initiatives grew, so did the number of radiology staff members presenting at the conference. Today the monthly agenda includes updates by general radiology, interventional, and MR technologists, a radiology nurse, and a radiologist, as well as presentations by guest speakers including the radiology liaison from the Children’s Hospital of Philadelphia Department of Quality and Patient Safety. The conference has served as a forum on hospital quality and patient safety activities, and when the hospital announces new initiatives in these areas, radiology has a ready mechanism to discuss and disseminate this information. The confer-
ence also has a favorable impact on department morale by flattening the hierarchy and providing a venue for all department members to raise quality and patient safety issues on equal terms in an open environment, often with lively and animated discussions. (Perhaps the best evidence of the conference’s success is the fact that it continues to be well attended despite the discontinuation of breakfast!) Furthermore, it has stimulated department-wide QI and QA activities, with staff members now requesting the opportunity to present at the conference so they can inform other department members of their particular quality and patient safety activities. Although the conference was instituted at an academic hospital, this approach would be equally effective in a hospital-oriented private-practice setting. It simply requires one or two departmental leaders who are interested in promoting quality and patient safety [4]. Having a multidisciplinary approach not only improves conference dynamics but also allows the conference responsibilities to be shared. To begin such a conference in your department, start with a basic agenda that includes a short educational component, a review of existing or any particularly troublesome departmental or hospital policies and procedures, and updates on turnaround times and other similar data that are available from the radiology information system, and end with an anonymous “missed” case. There are growing online resources and literature on quality in radiology to help you prepare the educational compo-
© 2010 American College of Radiology 0091-2182/10/$36.00 ● DOI 10.1016/j.jacr.2010.06.012
Quality Matters 809
nents, and you will even learn on the fly [5]. Be sure to keep the atmosphere open and nonpunitive, and over time you will find that the meeting will take a course of its own as people become more fully engaged and want to participate in quality and patient safety activities. Building a “community of practice” around quality and a quality conference can have a profound impact on the working culture of a department. A community of practice can help its members share best practices and obtain mastery. Gain-
ing proficiency in QI and practice management takes just that: practice. Sharing experiences and celebrating successes with a group of like-minded individuals provides a catalyst to attack and react to a potentially error-permissive environment and move toward a proactive and forward-looking culture. REFERENCES 1. Strife J, Kun LE, Becker GJ, Dunnick NR, Bosma J, Hattery RR. The American Board of Radiology perspective on maintenance of certification: part IV—practice quality im-
provement in diagnostic radiology. J Am Coll Radiol 2007;4:300-4. 2. Mainiero MB. Incorporating ACR Practice Guidelines, Technical Standards, and Appropriateness Criteria into resident education. J Am Coll Radiol 2004;1:277-9. 3. Donnelly L. Performance-based assessment of radiology practitioners: promoting improvement in accordance with the 2007 Joint Commission standards. J Am Coll Radiol 2007;5:699-703. 4. Campbell D, Thompson M. Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture. Am J Med Qual 2007;22:26-33. 5. Nagy P. Online radiology quality resources. J Am Coll Radiol 2010;7;459-60.
James S. Meyer, MD, is from the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Paul Nagy, PhD, is from the University of Maryland, Baltimore, Maryland. Paul Nagy, PhD, University of Maryland School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201; e-mail: [email protected].
PAUL NAGY, PhD
Building a Community of Practice for Quality James S. Meyer, MD, Paul Nagy, PhD A regularly scheduled meeting or conference is a straightforward and effective activity to help build a culture of quality in your department. This gathering should bring together interested parties across the spectrum of radiology care delivery and include radiologists, technologists, nurses, clerical staff members, and administration. The diverse nature of the group will provide a holistic perspective to understanding system processes that invariably cross boundaries of responsibility. This forum can help fulfill radiologists’ ABR Practice Quality Improvement Maintenance of Certification requirements [1] and residents’ ACGME IV systems-based practice requirements [2] and can assist in departmental preparations for a Joint Commission visit [3]. More important, a successful meeting can provide a valuable open channel of communication within a department and act as both an early warning system concerning systemic failures and an important bridge to maintaining healthy relations between the hospital staff and the physician practice. Another important purpose is to narrow the authority power distance and acknowledge the equal roles of the all department members in patient safety. In July 2005, a quality and patient safety meeting was initiated in the Department of Radiology at the Children’s Hospital of Philadelphia. The primary goal of this 1-hour monthly multidisciplinary conference was to promote an open and nonpunitive departmental culture of quality improvement (QI). Continuing medical education credit for physicians attending the conference was arranged to enhance attendance and help satisfy the Pennsylvania State 808
Board of Medicine’s biennial requirement for physicians for 12 hours of continuing medical education in patient safety or risk management (http://www.dos.state.pa.us/med). A light breakfast was provided. Each conference began with a “patient safety moment,” in which a patient safety activity was discussed and concluded with the review of an anonymous “missed” case. Other agenda items included an educational component as well as QI and quality assurance (QA) departmental initiative updates. Early on, the educational component constituted a significant portion of the conference, focusing on definitions and methods specific to the area of QI, Joint Commission regulations and activities (eg, National Patient Safety Goals), and departmental and hospital policies and initiatives. The number and types of departmental QI and QA initiatives grew, often as the result of discussions that had occurred at the conference. As the number of QI and QA initiatives grew, so did the number of radiology staff members presenting at the conference. Today the monthly agenda includes updates by general radiology, interventional, and MR technologists, a radiology nurse, and a radiologist, as well as presentations by guest speakers including the radiology liaison from the Children’s Hospital of Philadelphia Department of Quality and Patient Safety. The conference has served as a forum on hospital quality and patient safety activities, and when the hospital announces new initiatives in these areas, radiology has a ready mechanism to discuss and disseminate this information. The confer-
ence also has a favorable impact on department morale by flattening the hierarchy and providing a venue for all department members to raise quality and patient safety issues on equal terms in an open environment, often with lively and animated discussions. (Perhaps the best evidence of the conference’s success is the fact that it continues to be well attended despite the discontinuation of breakfast!) Furthermore, it has stimulated department-wide QI and QA activities, with staff members now requesting the opportunity to present at the conference so they can inform other department members of their particular quality and patient safety activities. Although the conference was instituted at an academic hospital, this approach would be equally effective in a hospital-oriented private-practice setting. It simply requires one or two departmental leaders who are interested in promoting quality and patient safety [4]. Having a multidisciplinary approach not only improves conference dynamics but also allows the conference responsibilities to be shared. To begin such a conference in your department, start with a basic agenda that includes a short educational component, a review of existing or any particularly troublesome departmental or hospital policies and procedures, and updates on turnaround times and other similar data that are available from the radiology information system, and end with an anonymous “missed” case. There are growing online resources and literature on quality in radiology to help you prepare the educational compo-
© 2010 American College of Radiology 0091-2182/10/$36.00 ● DOI 10.1016/j.jacr.2010.06.012
Quality Matters 809
nents, and you will even learn on the fly [5]. Be sure to keep the atmosphere open and nonpunitive, and over time you will find that the meeting will take a course of its own as people become more fully engaged and want to participate in quality and patient safety activities. Building a “community of practice” around quality and a quality conference can have a profound impact on the working culture of a department. A community of practice can help its members share best practices and obtain mastery. Gain-
ing proficiency in QI and practice management takes just that: practice. Sharing experiences and celebrating successes with a group of like-minded individuals provides a catalyst to attack and react to a potentially error-permissive environment and move toward a proactive and forward-looking culture. REFERENCES 1. Strife J, Kun LE, Becker GJ, Dunnick NR, Bosma J, Hattery RR. The American Board of Radiology perspective on maintenance of certification: part IV—practice quality im-
provement in diagnostic radiology. J Am Coll Radiol 2007;4:300-4. 2. Mainiero MB. Incorporating ACR Practice Guidelines, Technical Standards, and Appropriateness Criteria into resident education. J Am Coll Radiol 2004;1:277-9. 3. Donnelly L. Performance-based assessment of radiology practitioners: promoting improvement in accordance with the 2007 Joint Commission standards. J Am Coll Radiol 2007;5:699-703. 4. Campbell D, Thompson M. Patient safety rounds: description of an inexpensive but important strategy to improve the safety culture. Am J Med Qual 2007;22:26-33. 5. Nagy P. Online radiology quality resources. J Am Coll Radiol 2010;7;459-60.
James S. Meyer, MD, is from the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, and the University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania. Paul Nagy, PhD, is from the University of Maryland, Baltimore, Maryland. Paul Nagy, PhD, University of Maryland School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, 22 South Greene Street, Baltimore, MD 21201; e-mail: [email protected].