Why ask Why? QI!

Friday, October 21, 2011

It’s my pleasure to introduce Reena Gadhia, RN, MPH, Community Health Partnership’s Quality Improvement Program Manager as this week’s guest blogger!  Community Health Partnership’s Quality Improvement (QI)  team assists our member health centers and clinics with improving access to specialty care, preparing them for Patient Centered Medical Home accreditation, as well as providing other types of assistance and training.  Our Quality Improvement activities are an essential component for realizing our mission.  In partnership with our member health centers, we are able to build upon successful practices and streamline systems.  This critical work improves health care delivery and cost, thereby affirming our commitment to advocating for affordable, accessible, and patient centered care for all.

Hi everyone! I am excited to guest blog for Grace-Sonia today, who is away at the prestigious Women’s Policy Institute this week! My role at Community Health Partnership is as the Quality Improvement Program Manager.  This means that I work with our member health centers’ Quality Improvement clinic staff and managers to collect and examine data on clinical and process measures, facilitate learning and workgroup opportunities, and identify upcoming training needs.

So, what is Quality Improvement and why is it important? Quality Improvement, or QI, looks at the ‘how’ behind the ‘what’ and tries to make ‘what’ we do better.

At Community Health Partnership, we work with our member clinics to identify issues that they are facing in daily workflows, help them implement federal changes, and introduce to them new practices that may help improve their clinic work. We also collaborate with our member clinics to provide them with the resources, tools, and opportunities to make the changes that they would like to see.  This assistance includes trainings, analyses of data, facilitating groups around particularly sticky topics, etc. For example, one project that some of our clinics are involved in aims to ensure that diabetic patients older than age 55 receive standardized tests, medications proven to minimize complications of their condition, and lifestyle education. In QI, we receive data from the clinics on how many people are actually receiving these medications and education, and how their test results look – that is the ‘what’. But to understand deeper, QI takes the data and asks, for example: is there a larger focus on some health education topics and not on others? Why do more people seem to have their diabetes in control than last month? What processes are in place to make sure that these medicines get prescribed and patients receive the necessary health education? These questions, and many others like them, make up the ‘how’ of QI work. Understanding the activities behind the ‘numbers’ directly translates to patient care, as this information tells us where changes need to be made, whether it be in what providers communicate to patients, in who conducts health education (providers, health coaches, medical assistants, etc), in how clinics collect patient information, and on.

Increasingly in recent years, experts have discussed the critical role of QI in ensuring that health care delivery is ‘culturally competent.’ Broadly defined, culturally competent care refers to the ability of a health care provider like a nurse or doctor to not only respect the diversity of values and beliefs of their patients, but also to be aware of their own personal and professional biases and assumptions, and to be willing and able to tailor care so that it aligns with a patient’s personal framework. This is a tall order. It matters a great deal, though, because health care is more than the equally-important diagnoses and, medications: health care is people helping people! If there is limited understanding and connection between patient and provider, medical care is simply not as effective. So how does QI fit into ‘cultural competency’ in health care?

When we want to make big changes, the QI framework helps us to quickly implement small, ‘test’ changes and then assess them to determine if they work (and why, if so) or what to learn and change if they do not. In a field such as culturally competent health care which is still emerging and where there has not been a significant amount of research to tell us what the best practices are, QI is a critically useful tool to identify what will work for our own individual organizations. For those of us in QI, this means that we should give thought to how to assess possible disparities in our work and how to shape possible interventions to address these disparities (trainings, workflow changes, etc).  Questions to begin with include: what population do we serve? How effectively does staff serve the diversity of our population? What are our population’s needs? Are there disparities in the quality of care we provide?

As an organization that is committed to making health care more accessible and more affordable for multicultural communities, the marriage of QI and cultural competency seems especially salient. What are your experiences? How have your organizations addressed this issue?