By: Dr. Tom Sequist
At Partners HealthCare, we are always looking for ways to improve the quality and efficiency of patient care while lowering health care costs. One of the benefits of our integrated health care system is the ability to implement change on a large scale. As a part of that effort, the Partners Healthcare Clinical Process Improvement Leadership Program (CPIP) was launched in 2010 to engage clinical teams in quality improvement as a way to reduce variation in care from patient to patient -- and ultimately, to improve patient health. The CPIP course is led by co-directors Sandhya Rao, M.D. and Joe Jacobson, M.D., along with associate course director Brian Cummings, M.D.
CPIP is a four-month program that includes classes, expert advice, studies of past cases and group exercises. Participants learn to use proven, scientific quality improvement tools to improve health care processes. Projects allow participants to translate theory into action and help create measurable quality improvement in our system. Over 400 CPIP graduates have completed more than 200 projects, and two-thirds of graduates continue to work on their projects after finishing the program.
CPIP teaches a variety of quality improvement methods, such as:
- Creating a step-by-step chart to show how the current process works
- Identifying reasons why the current process works as it does
- Relying on solid data as evidence to support decisions
- Using cycles of learning and feedback to solve problems, engage colleagues in the work and increase the impact of their efforts
Participants attend the course in teams of two, usually a doctor with a nurse or an administrator. After the course, participants return to their doctor’s office or hospital to convene a larger, multi-disciplinary team to share what they learned and improve the processes they studied.
Reducing Hospital Stays for Bariatric Surgery Patients
One project at Newton-Wellesley Hospital focused on better meeting the expectations of bariatric surgery patients on departure time on their final day in the hospital.
Coordinating when patients leave the hospital after an inpatient stay is challenging since hospitals have to provide medical care on the final day, coordinate the correct bariatric surgery-specific diet, and work with the patient and family so patients can plan for a ride home. Since patients are frequently ready and eager to go home before their assigned time of day, the team focused on safely moving discharge times to earlier in the day.
Using the tools taught in the CPIP course, the bariatric surgery team confirmed that there was an opportunity to improve the process to allow patients to go home sooner. The clinical team improved the discharge process by managing patient expectations of discharge times, moving the diet program to earlier in the day, and improving other follow up procedures.
After implementing the program, the team was successful in getting patients out of the hospital over three hours earlier on their day of discharge.
“The course provides us with the tools to design and carry out process improvement, including interpreting the data correctly,” noted Newton-Wellesley project leader Dr. Sheila Partridge.
Improving Efficiency of Pediatric Intensive Care Unit Rounds
Another CPIP project completed at Massachusetts General Hospital (MGH) focused on having doctors use their time more efficiently when visiting Pediatric Intensive Care Unit (PICU) patients in the morning. Often the time of day and duration of these patient visits, or rounds, can vary based on how many patients or doctors are involved in the patient’s care. Without careful planning, rounds may extend late into the day and can result in decisions on patient care being made later in the day. Such delays can lead to less satisfied patients and staff and presents a challenge to delivering high-quality patient care.
In the MGH PICU, the CPIP team set a goal to complete rounds on their patients every day by 10:30 am using two steps. First, the team initiated a pre-rounds huddle between the attending physician and nurse to plan the rounding schedule and patient transfers. Second, the CPIP team provided doctor-specific feedback on meeting their goals for patient rounds, and coached staff so they learned from one another.
Within a year, pre-round huddles occurred 94 percent of the time and the number of rounds completed by the 10:30am goal increased from 77 to 90 percent of the time.
“The toolkits provided in the CPIP course opened our eyes to understanding and quantifying a problem before jumping to an intervention,” said project leader Arlene Kelleher.
Her project co-leader, Brian Cummings, M.D., agreed, “The experiential learning with a clinical problem was critical for us to plan our interventions in a systemic way to improve care. Now we see problems through a different lens and an eye towards measurement and proven progress, rather than just hoping things improve or assuming the intervention worked.”
Partners is working hard to help its doctors and hospitals collaborate system-wide to improve care, one patient and health care process at a time. By bringing together clinical leaders from across the network to learn from the best quality improvement experts and spread state-of-the-art techniques for quality improvement through the CPIP program, Partners plays a critical role in continuously improving quality and reducing costs for our system and our patients.
Read our last post in the “Higher-Quality Care” series.