This month’s blog is by Brian Liszewski, a radiation therapist at Sunnybrook Health Sciences Centre’s Odette Cancer Centre. He is the Quality Assurance Coordinator for the Radiation Therapy Program as well as a Practice-Based Researcher at the Sunnybrook Research Institute and Lecturer, Department of Radiation Oncology, University of Toronto.
I must make a disclosure prior to delving into this month’s journal article. I do have a vested interest in the Quality Conversations (QCs) described in the article. Being involved in the large scale roll out of QCs across all of Sunnybrook Health Sciences Centre, frankly I think they’re just super. But what I think is anecdotal. What’s so super about them? Is my opinion based on experience, observation, what is the evidence that QCs are a benefit to the organization? More importantly, what is the evidence that they should be adopted by other units or considered by you, the reader? This is the burning platform that helped fan the fire of QCs. Quality conversations help reframe how we respond to anecdotal observations into evidence based quality improvement approaches, to address programmatic performance.
Team huddles have existed for in both healthcare and industry for a while, and have been a real success. They have a demonstrated benefit for the staff involved, improving communication and teamwork. But, these huddles tend to focus only on the “flavour of the day”. These discussions solve the problem facing the team that day, but often do not address the underlying causes that may be contributing to that “flavour of the day”. That being said I don’t want to detract from the benefits of huddles; shown to improve information sharing, accountability and staff growth they are an excellent addition to a department. The question remains how do you identify if you simply have that problem in your program that bugs everyone and can be an easy fix or is it something that needs a deeper dive? This is where Continuous quality improvement (CQI) comes in. CQI is one of those buzzwords that captures a whole host of tools, but simply boils down to the concept of looking at a problem, trying to understand it better, coming up with a fix and seeing if you made it better and hopefully not worse. It gives a program the chance to see it can cut down on waste, do things more efficiently, and make staff and its customers happier. The key message is whatever changes you make are informed by some evidence and that you keep an eye on your changes and redirect your course if things aren’t quite going as you predicted.
Now that we have an idea of what tools are out there to make improvements and keep them going. How do we start putting them into place? We’ve probably all heard of some really great ideas that came from some senior leadership or corporate level that went over like a lead apron (see what I did there, I made the analogy radiation related). What might be a reason for these failures? For initiatives to be successful it’s important to recognize you need staff buy-in. A grassroots approach, helping staff understand “What’s in it for me?” is integral to success. Not only, do you need staff buy-in for the success of a team based initiative, but also you need to work with the team to transform them into one that is highly effective. There’s another buzzword and how do you transform your team? Well, let’s look at a team in medical radiation technology setting. We work with so many others in the healthcare system to succeed in our jobs as well as each other. As we discussed early team huddles help us communicate better and grow. But we also need to start breaking down those barriers among the other professions. I can think of an instance working on a CQI project with an inter-professional team in which each profession thought the other was responsible for the task we were trying to solve… Smashing down those silos we work in, improving communication, clarifying our roles, and resilience in the face of challenges and change result in a highly effective team.
Putting it all together:
We’ve touched on some quality improvement topics and how they relate to team dynamics. Team huddles are a pretty good approach, but tackle problems with a more ad-hoc basis. They are more effective at improving communication and accountability. CQI is the powerhouse tool a program needs in order to fully understand, address and follow-up on recurring issues. Finally, huddles, CQI or any other initiative cannot succeed unless you can get your front-line staff on the trolley. How do these relate to this month’s journal club paper? Well, I’ll tell you; those super QCs feature elements of all of these concepts.
By marrying those nuggets of traditional team huddles with a heaping spoonful of CQI theory the authors discovered that their QCs increased awareness of best practices suggesting that QCs are a good forum to discuss ideas for change, implement new processes, monitor progress, and evaluate outcomes. In addition, providing participants the opportunity to provide feedback, validate that feedback and participate in change the authors noted a positive response perception that regular conversations with the team will improve quality and safety. Finally, the embedding inter-professional elements into QCs was expressed as a future direction “being able to contribute ideas with other colleagues from different teams that would help with patient safety and efficiency and seeing it play out and what results/outcomes come out of it’’ which has subsequently been regularly integrated into QCs.
When it comes to assessment that QCs are super, is my opinion based on experience, observation? What’s so super about them? Not only are QCs an excellent to integrate CQI into practice, it is evidenced that they also instill CQI into the attitudes and perceptions of those whom participate. Finally, as evidenced that this paper is even written, QCs are CQIs themselves, constantly being reassessed for opportunities for improvement. In conclusion, QCs are just super… so what are you waiting for? Go get one started!
- Gillan et al. The Quest for Quality: Principles to Guide Medical Radiation Technology Practice. JMIRS. 2015. 46(4); 427–434
- Goldenhar, L. M., Brady, P. W., Sutcliffe, K. M., & Muething, S. E. (2013). Huddling for high reliability and situation awareness. BMJ Quality & Safety, 22(11), 899-906.
- Liszewski, B., Angers, C., & Kildea, J. (2017). Mitigating the Barriers to a Culture of Quality and Safety in Radiation Oncology. Clinical Oncology, 29(10), 676-679.