Conversations With Leaders - Kasia Filaber (The Four Villages Community Health Centre, Toronto)
1. What does quality improvement (QI) mean to you?
To me, QI is an opportunity to engage in a thoughtful and organized way to improve the efficiency of a process, and ultimately achieve better outcomes for our clients/patients. This positive change is arrived at through some trial and error, so it is not necessarily a totally straight line to success, but the goal is for the new process to get better results and to replace the old and inefficient ways of doing things prior to this change.
2. Why did you embark on your most recent QI project?
My organization had performance targets in place, but had challenges in reaching these targets. We focused on QI initiatives to improve rates of cancer screening and access to primary care and used the tried-and-true QI framework and tools for approaching organizational change. The goal was to uncover the root causes of our failure to achieve our targets, and ultimately to create more efficient processes to maintain the desired level of performance.
3. From a leadership perspective, what are the factors that make a QI project successful?
There are many factors that contribute to making a QI project successful. I will focus on only a few.
The QI project has to have the blessing of the top leader and dedicated resources: appropriate staff and time for staff to participate.
A QI team has to have a leader who has the authority to make decisions and implement process changes and the right staff who are connected to the process to be improved or have a stake in it.
The project has to be clearly defined, with a beginning and end, as it is very easy to slip into the “I can/should do everything I can to improve everything that needs to be improved because everything is related to everything else”.
There needs to be a clear understanding that QI takes time and that the journey to make the changes is as valuable as making the necessary improvements. One of the benefits is that staff learn tremendously during a QI process and can later apply this knowledge to other aspects of their area of responsibility. Also, small tests of change need to be made before big roll-outs of new processes take place. Understanding the issues, collecting quality data to support decisions and to measure progress all take time.
When properly set up, QI engagement gives staff a sense of autonomy and agency and makes them more invested in their work.
It is helpful to start with small QI projects to gain trust from staff that changes are possible and desirable and that their jobs are not at stake. Staff need to see and experience it, not just be told.
While QI takes time, small changes can be implemented that will create trust in the project. Staff cannot wait too long for improvements to be made, as they will lose interest and trust in the process.
Appropriate stakeholders have to be involved, that is everyone who is touched or invested in the process or its outcome. This includes the clients for whom we are making the changes.
4. What do you think about data quality in the healthcare system?
I am aware of several challenges with data quality within our Community Health Care (CHC) sector and other parts of the healthcare system:
Different definitions and understanding of similar data elements and indicators
Different ways of measuring the same indicators, so our measures are not reliable and cannot be compared
Data are missing and input varies depending on the understanding of the data elements
We are unable to compare what seemingly are the same data elements within and between sectors
There is different capacity and resource allocation for data collection and analysis and for maintaining data quality in different sectors within our system
Data could be shared more effectively and efficiently to help with comparing one’s organization to the best performers, to learn from one another, and to make improvements across the system
5. Have you used QI to improve data quality? if yes, in what way has QI improved the quality and quantity of reports you receive?
While with the West End Quality Improvement Collaboration (WEQIC), we established common definitions of measures and indicators across the CHCs participating in the collaborative. We also clarified the language used to define data elements (as technical specifications for the data elements were interpreted differently), measures and indicators so that we had comparability across the participating CHCs.
My organization developed a better understanding of what measures we needed to collect and why, which led to a more judicious use of reports (to run reports that were meaningful and were providing relevant information for making decisions), and greater trust in the quality of reports generated, both from management and staff with whom we shared some of the reports.
6. If you worked with other organizations to improve performance, did the collaboration change how you do QI?
I worked with the West End Quality Improvement Collaborative (WEQIC). The partnership improved my and organizational capacity to do QI and my confidence in tackling other performance challenges with QI approaches.
I can confidently say that I Improved my skills and understanding of how QI processes work, my knowledge of various QI tools and how to apply them.
In the future if I do QI I will look for opportunities to work with other agencies. There are numerous benefits of working in a collaborative manner.
7. What is the benefit of the collaborative?
There were many very important benefits of conducting our QI projects within a collaborative (the WEQIC).
For directors:
Having a specialist hired by the collaborative was immensely beneficial. The specialist was able to support the project management aspects and to move it along, to support every partner CHC where they needed the help and from the point of where they were at (as there were differences between CHC in their QI knowledge, experience, data quality, how processes were set up, etc).
Increased QI knowledge and skills that were reinforced by sharing the learnings throughout the length of the partnership
For staff:
Staff learned about QI processes and tools and learned to utilize the tools to improve various process not formally part of the larger QI project. So QI became ingrained in the life and work of the organization and was not just an additional project to get through
Better understanding and appreciation of each other’s roles and new respect for various team members and roles within our individual organizations but and also between the participating CHCs
Learning about data, importance of good and reliable data, data entry, increased trust in our own data
Data managers learned new skills, better understanding of their roles and the challenges they faced. Their standing as an important staff member improved.
Organization:
We made tangible, significant improvements in performance for the processes we were focusing on.
We built a stronger QI culture, an understanding that QI is not a one-off project, that quality improvement is a continuous process and there is always an opportunity and a way to improve further.
With better understanding of each staff’s roles we had better communication within the organization and between our CHCs.
Staff started working in extended roles, to full scope
It was very helpful to understand that QI is not the same as research, we were going for “better” and not for “perfect”. This really freed up a lot of energy and creativity.
Ability to achieve other benefits, which had not been anticipated prior to forming the collaboration:
Standardization of knowledge, processes data, measures, and definitions.
Improving quality of our data.
Exposure of our staff to other CHC staff and learning from each other.
Greater understanding of the limitations of our EMR, and of the databases maintained by the sector.
For partners:
We have created a stronger sense of ownership and collaboration amongst the participants at all levels.
Opportunity to compare CHCs that are part of the collaboration, because we standardized our data and used the same definitions of measures and indicators.
Building trust between partners and stronger relationships led to more sharing (lessons learned, sometimes of failed changes, data, good practices)
We developed common tools to be used by individual organizations (economies of scale)
Common QIPs for the QI processes we were working on, eg. cancer screening.
Across the system:
Building relationships with external stakeholder, eg CCO
Sharing lessons learned with other CHCs who were not part of the collaboration, presenting at conferences.