On 1/12/16 after a long hiatus for the holidays our group met again to discuss our progress thus far and to plan out our next PDSA cycle.
I won’t summarize all of the learnings from the last PDSA cycle, but highlight a few key issues that we identified as major obstacles that needed addressing to maximize our potential for success.
#) Unclear Front Line Buy-in: Critical to behavior change is involving the front-line staff in developing the plan for the intervention. Not only do these front line workers have the expertise about the nitty gritty involved in changing processes, but they also have the most at stake and need to feel like their opinion is valued. Early in the project we had tried to get LVNs to attend our meetings and work with the team, but this was quite difficult due to scheduling restraints and likely very different working cultures. Nevertheless, given how important this step is, we decided to redouble our efforts to meet with the LVNs, explain the rationale behind the project, and incorporate all of their feedback into the process. We also discussed giving them as much positive feedback and recognition as possible to help them get credit for helping with the project.
#) The Devil is in the Details: Our first PDSA pointed out multiple easily fixable but very relevant flaws in the execution of the plan. Things like where to position the paper to best fit into the work flow, how to ensure the return of pens and clipboards, and how to gather these forms from providers all created barriers to implementation. For our next phase of the project we are working to address these and make it easy to do the desired behavior.
#) The Importance of Stories: As time marches on projects inevitably begin to feel a bit old. Everyone gradually starts to lose enthusiasm and maintaining commitment and investment in something as difficult as behavior change becomes really important. Today our group took a moment to reflect on why we think this project is actually very important. A number of our group members shared stories of patients who didn’t have their top concern addressed, or situations where a “door knob” question came up that caused a provider to fall behind because of the delay and then have other patients leave unseen so they could catch the shuttle. This served to reanimate the group and remind us of the overall goal of these QI projects- to improve the quality of care we provide to our veterans here in the clinic.
We plan on launching PDSA #2 soon. Stay tuned for details and results!