My QI Story
Monday, April 1, 2019
Discovering Quality Improvement
Rachel S. Nash, MD, CMQ
Quality Improvement and Patient Safety first came alive for me in medical school. I had the opportunity to participate in the Telluride Patient Safety Summer Camp after my MS2 year. Perhaps it was the fact that I had finally finished taking my exam, or the idyllic mountain air, but that week learning about patient safety from national experts and being surrounded by like-minded individuals was truly life-changing. I returned to medical school at GW determined to be the MS3 to 'speak up' about safety on rounds and teach others what I had learned.
Unbeknownst to me, the current of the 'hidden curriculum' in clinical rotations was strong. I realized I couldn't be the lone rower on a huge ship in order to change the culture of safety at my medical school. Working with faculty, during my fourth year, I planned and executed an inter clerkship-day for 180 third-year medical students on patient safety. I convinced Sorrel King of the Josie King Foundation and author of “Josie's Story” to share her personal experience with medical error, and had leaders from national Quality Improvement organizations engage students in a panel discussion. I brought back communication skills exercises from Telluride, and had students practice these skills in small groups.
Residency at Thomas Jefferson University Hospital in Philadelphia, Pennsylvania, was another culture challenge. My main goal was to survive my intern year, and once my head came above water, I realized that a robust QI/Safety infrastructure existed, but there was poor buy-in from other residents and even program leadership. During my residency, I worked on a project targeting 30-day readmissions and giving residents access to their own readmission rates with the goal of personal practice improvement. I also led a subcommittee on Jefferson's Opioid Task force, aiming to address the opioid epidemic and improving physicians prescribing habits of narcotics. This work led me to the ACMQ meeting as an ACMQ Scholar and I was able to obtain CMQ certification.
My background in QI and safety, and experiences as an ACMQ certified member, greatly helped my job search as an academic Hospitalist. Now at Cooper University Hospital in Camden, New Jersey, I get to start over again! I am lucky enough to work with residents everyday as an Assistant Program Director, and with medical students from CMSRU. This year, after attending the Quality and Safety Educators Academy (QSEA) run by the society of Hospital medicine, I have the tools I need to build a curriculum around patient safety and quality for the residents.
I see the path ahead as an alignment of goals. Many Hospitalist programs struggle with the competing priorities of caring for patients with complex medical conditions, while striving to achieve various quality metrics and maintaining a commitment to teaching.
Seeing the world through a quality lens helps me understand the importance of aligning QI projects with the overall safety and quality goals of the institutions. I see myself as a bridge between learners, educators, and administrators.
Although QI can be challenging, what fulfills me is empowering others to change the system around them to make things better for patients. By teaching the language of QI, I want others to realize that quality improvement is not a scary tangle of metrics and RCA's. Instead, it's an opportunity to focus on the core tenets of good communication and putting the patient at the center.
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