VA Primary Care Quality Improvement Project

Today the first group of residents from the VA primary care clinic embarked on their quality improvement project and I’m fortunate enough to get to mentor the team on Tuesday/Block A at the SFVAMC.

These projects are an annual tradition at the VA in which our housestaff at all VA sites team up with other health care trainees (nurse practitioners, psychologists, pharmacists, nutritionists) to work together to improve the quality of care for their patients and how the clinic operates.

While the projects are not without their flaws, they offer a really unique opportunity to get to work in multidisciplinary teams, try to change something that you care about, and learn QI. I think the greatest benefit in doing these projects comes from the actual experiential component of not just hearing about QI concepts and techniques, but being forced to apply them to solve a real problem in the clinic.

For the VA primary care project, we teach the Institute for Healthcare Improvement’s Model for Improvement framework to approach QI, which really revolves around three simple questions and rapid cycle improvement.   However, the first step in any good improvement project is asking the front line staff what needs to be done better. While the residents might have limited QI experience, they really are experts in the day to day practice of healthcare delivery in the clinic and know the most about the pain points and opportunities to improve.

Today after much discussion, our group settled on doing something around a pre-visit patient form to gather info on what the most important issue to the patient for discussion is that day, what meds they are taking, etc. We have starting asking additional stakeholders for their input, doing a brief lit review, and are going to think about directions to take the project and metrics before our next meeting. More to come as the project develops!

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