My QI Story: Donna M. Daniel, PhD
Monday, September 30, 2019
Improving the Quality of Care One Act at a Time
Donna M. Daniel, PhD
It seems that my career journey has taken several turns – all exciting opportunities to marry evidence-based medicine with quality improvement!
My QI story starts with my first career as an epidemiologist for the Centers of Medicare & Medicaid Services (CMS)’ Quality Improvement Organization (QIO) program. CMS has evolved this program from one that peer-reviews medical records to one in which quality improvement specialists, clinical experts, and consumers are partnering with providers who deliver care to Medicare beneficiaries. QIOs collaborate with providers in their region to lead data-driven quality improvement and patient safety initiatives to improve the health quality for beneficiaries.
Next, I transitioned to a three-state QIO headquartered in Seattle, Washington and had the pleasure of working with Dr. Edward H. Wagner, father of the Chronic Care Model. I was selected as a member of a small team that trained closely with the Institute of Healthcare Improvement (IHI) on implementing their Breakthrough Series (BTS) Collaborative model. During this time, I had the pleasure of serving as improvement specialist for the first statewide diabetes collaborative. From this work, a partnership emerged between our team, CMS, and IHI leading to a performance improvement support center which offered training programs, workshops, and expert speakers focused on improving care delivery in hospitals, office practices, long-term care facilities, and home health agencies. We were able to test variations on the IHI BTS Collaborative model and I learned the value of improvement science.
My next turn took me to New Jersey where I had the pleasure of working for Dr. Don Casey at Atlantic Health System. Serving as his corporate director for quality measurement and improvement, I learned first-hand how to apply improvement science within the walls of a health system, at the system-level, hospital-level, service-line level, clinician-level, etc.
In 2010, I had an opportunity to join a national demonstration program, the Safety Net Medical Home Initiative, funded by the Commonwealth Fund and focused on transforming 75 federally qualified health centers or look-alikes in five regions to patient-centered medical homes. We had five years to develop the curriculum, hire and train medical home facilitators, recruit the FQHCs, and produce measurable results. By the end of the initiative, 83% of sites achieved external recognition as medical homes. Part of my role was synthesizing the general lessons learned while recognizing the regional differences that existed.
Just as this demonstration program was ending, the American Medical Association (AMA) brought me on board as the operational lead for their cardiovascular disease prevention efforts. This was an opportunity to hire a team of clinical and non-clinical quality improvement specialists and partner with Johns Hopkins’ Armstrong Institute for Patient Safety and Quality which at that time was led by Dr. Peter Pronovost. We recruited 10 pilot sites and five patient advisors to develop a curriculum, training program, and set of tools which translated the hypertension guidelines into actionable care delivery. Scalability and sustainability was our next challenge, but with the right partner, it was doable. To scale this effort, the AMA has partnered with the American Heart Association and this program is now available as Target: BP.
I have been fortunate to work with many great leaders in quality improvement, patient safety, and transformation. I have had the pleasure of being part of multiple leadership teams that developed national programs which I believe are positively impacting the health of our nation. Being a member of ACMQ, faculty for its Quality Institute, and a member of the Education Committee have kept me close to those who share my passion for translating evidence-based medicine into actions which lead to high-quality care delivery and community health.
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