Booster Shot

Sometimes I wonder: Is there anyone else out there?

When I go for a stretch without connecting with anyone who's engaged in quality improvement work, I feel a little isolated.

But I’ve had a great couple of weeks, with plenty of chances to connect with people who are truly excited about the quality improvement opportunities they’re pursuing.

I started out at HQC’s Clinical Practice Redesign (CPR) school. Participants from clinics and health regions are learning to apply QI techniques in their clinical work.

And they ask some tough questions, like “What would you do differently, if you could do Advanced Access over again?”  Ummmm…2 things.

First, I would ask for more time set aside for this project. When I took on the Urology Division head position, I asked for a half-day every month to pursue administrative activities. I usually split that into two 2-hour chunks. At the time, I thought that was a lot to ask, given that our practice is fee-for-service and administrative work doesn’t pay the bills.

Ha! What a rube! I got owned… big time.

I spend easily triple that time on admin/QI work. That means staying late at the office, or doing work in the evening. It also means that clinical work sometimes piles up, and I may get behind on paperwork and phone calls.

And, even with that extra work, my QI to-do list keeps getting longer.

Know what? I think I just convinced myself to ask my partners for more time! They’ll have to decide how much they value the work I’m doing.

Second, I would communicate more about the project. I would post regular updates of our progress in the office, so that staff and physicians would be up-to-date and more engaged in the process. I would also like to have more meetings with the entire office staff. The meetings that we have had have been a goldmine of ideas.

Earlier this week, I got to attend the Chronic Disease Management (CDM) Collaborative meeting. I told our office’s Advanced Access story, but also participated in one of the sessions on how to improve care in one of the Collaborative’s newly selected chronic diseases: depression. Imagine that! A urologist thinking about treating depression! I thought I would be a fish out of water.

But I wasn’t the only fish. Many CDM participants work in diabetes care, and attended because of their involvement in earlier CDM initiatives. I discovered that everyone had expertise to contribute, framed in his or her own experience. The multidisciplinary representation made the discussions much richer. I guess that’s why HQC likes to spell Collaboration with a big-C.

I met a diabetes nurse specialist who works with the endocrinologists at Royal University Hospital. These physicians have been in extremely short supply and their backlog/wait times are huge. The nurse specialist told me that implementing a pooled referral system has been a big help in managing their wait times. I hope she’ll be able to share the data so I can post it here. How exciting to discover another specialty practice that’s implementing CPR techniques!

I loved the enthusiasm of all the attendees. It was a big booster shot of QI for me.

During the time I was at these meetings, I’ve had a senior medical student spending 2 weeks with me. In our division, we regularly have medical students doing clinical rotations, so I wasn’t surprised when she contacted me. I was surprised, however, when she told me her objectives for the rotation:  She wanted to learn about Advanced Access and CPR, as well as urology! Well, that was a first, and I was a little unsure how to approach teaching what she was interested in.

In the end, it worked out great – for both of us, I think. I enjoyed discussing patient encounters from both the urology and CPR points of view. I must admit that I do rant to students about QI/Advanced Access, whether they want to hear it or not. This time though, she was an enthusiastic and thoughtful participant in the discussion. It’s great to be challenged by a fresh point of view.

It’s so important for us to build a QI community, not only to accelerate change on behalf of our patients, but for the mutual support and encouragement that sustains us all. Over the last 2 weeks, that community has energized me. Now, I want to recruit more members.

If you see me coming toward you with that QI glint in my eye, remember this: I’m not looking for someone to share the work.

I’m looking for someone to share the fun.