Quality improvement (QI) projects usually cut across multiple clinical disciplines. An effective QI committee should comprise of an ad hoc team made up of representatives drawn from the affected practice areas that ideally report to the facility’s CEO. The QI committee holds regular meetings to identify the practice domain for improvement and evaluate/monitor progress. It involves QI champion groups dedicated to ongoing quality improvement efforts, feedback, and project implementation to fulfill the hospital’s mission. The meetings primarily entail collecting and reviewing performance data and engaging all affected individuals. This paper describes a plan for a quality improvement meeting meant for CAUTI prevention at the Kendall Regional Medical Center.
Staff Associated with Quality
Based on a review of Kendall’s organizational chart, the potential members of the interdisciplinary QI team will include the hospital CEO, CFO, CNO, Directors of Department, Director of Staff Development Department, Charge Nurses, Infection Preventions Officer, and staff nurses who will be part of the Champion group. The reason for having such an inter-professional QI team is to tap the diversity of roles and perspectives to support CAUTI prevention efforts at the facility.
The diverse membership will cover roles such as clinical leadership (the CNO and directors) that will test and spearhead the implementation of the change. Infection preventions officer and staff nurses will provide technical expertise in CAUTI prevention while the charge nurses will provide day-to-day leadership roles, including review and analysis of data. The CFO will facilitate the acquisition of resources/finances required for the QI project. The QI committee will report and notify the hospital CEO of the project’s progress and milestones achieved.
Risks Associated with Working with Inter-professional Teams
The inter-professional team will bring together professionals from diverse disciplines to provide integrated preventive care for CAUTI. However, unclear scopes of practice of each professional in collaborative practice constitute a significant risk to inter-professional collaboration (Samuelson, Tedeschi, Aarendonk, de Cuesta, & Groenewegen, 2012). In particular, physician concerns over the level of responsibility for actions performed by other members may be a barrier to effective interdisciplinary practice. Further, the issue of who bears the ultimate responsibility in cases of negligence can impede collaborative practice. To address these risks, the individual professionals in the team will be required to act within the respective standards of care or scope to enhance professional accountability in the CAUTI prevention and resolve the issue of legal liability.
Other potential risks in collaborative teams include communication lapses or omissions in reports. As Supper et al. (2014) put it, the failure to share critical patient information with other professionals, document individual actions, and delineate duties and roles in a QI project is a barrier to unified and integrated care. Therefore, incomplete information on aseptic insertion and catheterization indications could affect coordinated care and increase the CAUTI risk. In this project, the best practices to avoid such risks will include bedside shift reporting and whiteboards to support clear inter-professional communication.
Pre-meeting Review
Before the QI subcommittee meeting, I would want the team to review the practice improvement plan (PIP) for CAUTI. The pre-kickoff meeting review should also determine the plan for data quality improvement and implementation deliverables for CAUTI prevention as well as timelines. Specifically, I would want the team to discuss the CAUTI prevention interventions, baseline data variables, and data-reporting schedule that will become the agenda of the first meeting. The team will also review the action items and education opportunities for members to build capacity for change. The items reviewed will form the agenda for the kickoff meeting.
Obtaining Buy-in from the Team
Building trust relationships is a critical step in obtaining stakeholder buy-in and overcoming resistance to change. I would use evidence-based strategies to obtain buy-in from the QI team for the CAUTI prevention project. Effective internal communication and advocacy for the QI work will make the team more receptive to CAUTI prevention work (Liddy, Blazhako, Dingwall, Singh, & Hogg, 2014). The practice communication will involve articulating the goals and outcomes of the QI project in meetings and via blogs. Also, creating an open and engaging atmosphere that caters to the diverse practice needs will enhance the team’s willingness to change. Providing consistent and helpful information, including articles on early adopters of CAUTI prevention, will instill awareness of QI in hospital performance ratings (Davis et al., 2014).
Another strategy will involve targeting practice leaders within the team. Convincing these nurse champions about the necessity of CAUTI prevention will help obtain buy-in at the unit-level. Further, communication messages should be tailor-made to specific audience groups, including clinicians, administrators, to resonate with the diverse team members’ needs and characteristics (Lemak, Cohen, & Erb, 2013). The messages will emphasize on the rewards or benefits of the QI project for all practice lines. The messaging methods should also be tailored for specific groups, e.g., peer-to-peer education for staff nurses and benchmarking for the leadership (CNO and CFO).
SMART Goal
To achieve the team’s buy-in, my SMART goal defines the specific numeric targets of the support, time frame/period, achievability, and relevance as follows: The facilitator will use evidence-based strategies to achieve practice buy-in resulting in 80% of the team membership indicating their support and engagement in CAUTI prevention efforts by January 31, 2017, as measured through practice assessments/feedback.
Agenda for the QI Team Meeting
- Review the PIP for CAUTI prevention, including the aseptic insertion and guidelines to be adopted.
- Develop schedules for future team meetings and venues.
- Determine the variables to include in quarterly reporting for progress evaluation.
- Decide on the intervention arm (aseptic equipment, catheterization equipment, or hand hygiene) allotted to each practice in the team.
- Inform the members of the available e-learning opportunities for each intervention group.
- Educate the members on the data reporting process and baseline data tracking.
Assessing the Meeting’s Success
I will assess the overall success of the meeting based on whether its objectives are met, communication effectiveness, clarity of the discussion, and practice feedback. The indicators of a successful meeting will include the purpose (CAUTI prevention) is clearly stated at the beginning, the agenda is reviewed, meeting roles are made clear, and the transition between action items is easily understood. Also, interaction among the members should be clear, and respectful and diverse perspectives on CAUTI prevention acknowledged. Positive feedback from the attendees will indicate a successful meeting.
Conclusion
The QI work will involve interdisciplinary collaboration that will bring together diverse practices engaged in quality at Kendall. The team members’ roles will include clinical leadership, technical expertise, day-to-day leadership, and sponsorship or facilitation. Providing standards of care for each practice and bedside reporting requirements will reduce risks related to legal liability and miscommunication that increase the potential for CAUTI. Effective communication and engagement will also help achieve buy-in from the members and lay the ground for the kickoff meeting.
References
Davis, K., Colebaugh, A., Eithun, B., Klieger, S., Meredith, D., Plachter, N.,…Coffin, S. (2014). Reducing catheter-associated urinary tract infections: A quality-improvement initiative. Pediatrics, 134(3), 145-152.
Lemak, C., Cohen, G., & Erb, N. (2013). Engaging primary care physicians in quality improvement: Lessons from a payer-provider partnership. Journal of Healthcare Management, 58(6), 429-443
Liddy, C., Blazhako, V., Dingwall, M., Singh, J., & Hogg, W. (2014). Primary care quality improvement from a practice facilitator’s perspective. BMC Family Practice, 15, 23-31.
Samuelson, M., Tedeschi, P., Aarendonk, D., de Cuesta, C., & Groenewegen, P. (2012). Improving interprofessional collaboration in primary care: Position paper of the European Forum for Primary Care. Quality in Primary Care, 20(4), 303-312.
Supper, I., Catala, O., Lustman, M., Chemla, C., Bourgueil, Y., & Letrilliart, L. (2014). Interprofessional collaboration in primary health care: A review of facilitators and barriers perceived by involved actors. Journal of Public Health, 1(3), 1-12.