2013-2014 Quality Improvement (QI) Projects
Rouge Valley (1 QI Project)
Location: Ajax/ Pickering
The student team will have the opportunity to choose from two projects:
a. Project Zero: Eliminating Hospital Acquired Clostridium Difficile Infection (CDI). A multi-faceted approach which may generate PDSA cycles for change ideas associated with respect to Staff and Patient Education, Surveillance, Room Cleaning, Equipment Cleaning, Antibiotic Stewardship, Isolation Protocols etc.
b. Refining and pilot testing Isolation Signage on select medical, surgical and post acute care units.
Sick Kids (3 QI Projects)
Location: Downtown Toronto
Projects for this year will be focused on improving availability and right sizing the patient care supplies for a number of units at the hospital. We have several units that are looking for support. The teams can expect to be exposed to improvement methods, experience PDCA cycles, meet numerous clinical staff and perform some interesting analysis using Excel. We could potential support 5 teams if there is demand from the student side of the program.
Toronto East General Hospital (1 QI Project)
Location: Coxell & Danforth Ave.
Project teams have the opportunity to choose from one of the following four projects:
• Barriers to Hand Hygiene: TEGH is aiming to improve hand hygiene compliance hospital-wide as part of its annual Quality Improvement Plan. Through various tactics implemented in the past few years, TEGH has been able to increase hand hygiene compliance to the mid-80% range. TEGH is now looking for strategies to improve this even more. Examples of strategies may include providing real-time notification and feedback to staff members, and a process to collect more data samples to more accurately measure performance. The solutions generated will be up to the students pending their observations and analysis of root causes.
• Lab Specimen Labeling: Errors in labeling specimens to be processed by the lab can cause delays in treatment, re-work and adverse events. TEGH is aiming to reduce mislabeling of specimens as much as possible to ensure patient safety and reduce waste in its care processes. There are many variations in workflow processes from unit to unit at TEGH, leading to many reasons why mislabeling occurs. This project will focus on specific units (such as the Emergency Department) and will identify root causes for mislabeling. Students will design and implement solutions to reduce specimen mislabeling.
• Staff Flu Vaccines: As part of maintaining staff wellness for the upcoming flu season, TEGH is focusing on ensuring that as many staff as possible opt to vaccinate themselves against the flu. Historically, between 50-70% of staff have been vaccinated, but TEGH is hoping to increase this number. This project will focus on developing strategies to increase compliance with the flu vaccine, and can include root cause analyses, surveys, data analysis, etc. to design tests of change.
• Patient Experience Feedback: Currently, TEGH has multiple avenues to solicit patient feedback: post-discharge phone calls, NRC Picker surveys, Manager-Patient rounding, and the Patient Relations department are some of these avenues. TEGH is looking for a more coordinated approach to proactively gather patient feedback and communicate this feedback to the appropriate units, departments and individuals to ensure timely feedback is given and acted on to improve the patient experience. This project will focus on prototyping a process through various tests of change.
North York General Hospital (2 QI Projects)
Location: Leslie & Sheppard Ave.
Staff in the Locating Department work in a busy area where they are multitasking doing work that has a significant impact on patient care while providing good customer service. Frequently the calls Locating staff receive occur during emergency or critical times e.g. patient requires emergency surgery and surgical staff need to be called in on off hours or an emergency preparedness event is called and mass notifications need to be sent in a timely manner. Failure to complete these tasks in a timely manner can result in poor outcomes for patients, results of these calls can be used in medical legal claims as evidence that North York General Hospital (NYGH) has or has not completed their due diligence. The project we would like to submit would be based on Locating staff receiving call from others requesting certain people are contacted, this would include identifying how each person is contacted correctly the first time. Risk issues that are seen in this current process include efficiency (timeliness is important), variability in procedures (there are different inputs but the output needs to be consistent) and customer service (even under duress we need to ensure that we remember who the customer is). Delays in contacting the appropriate person poses a risk to both patients and NYGH. I would see this project being in parallel to a larger quality improvement project in this department.
Problem: Access to pillows is a supply chain process that when inefficient and inconsistent are frustrating and time wasting for patients, families and staff, within our Emergency Department (ED). The lack of pillows is also a contributor to patient experience.
Background: Patients who come to the Emergency Department are usually frightened, anxious and in pain. The wait to be treated may be long and the comforts while waiting may be minimal. Patients may be on a stretcher for many hours while they wait for testing and treatment or transfer to an inpatient bed. To patients and families small comforts make a difference and one of those comforts is a pillow. When pillows are not available patients may use a blanket, rolled up coat, baseball glove or whatever may be handy to create a place to rest their head. This is neither the resource nor the experience we strive to have for our patients.
Staff in the Emergency Department recognize that pillows play a role in the patients comfort and their experience; however access to pillows is an ongoing challenge and frustration for them. When pillows are not available staff spends time searching for one which is not an efficient use of their time and in fact may result in a pillow not being found. Staff daily ask the age old questions “where do all the pillows go and why do we not seem to have any?”
In looking at this process there are 3 major steps that require review and the development of an improved system. These include:
1. Supply of pillows to the Emergency Department throughout a 24 hour period
2. Pillow cases available and on the pillows so that they are ready for patients
3. Storage solution whether centralized or decentralized
St. Joseph’s Healthcare Centre (1 QI Project)
Location: The Queensway & Roncesvalles Ave.
The Pediatric department at St. Joseph’s Health Centre is reviewing their processes within the inpatient unit and outpatient clinics. A continuous improvement event is scheduled for late September/early October to review the process from beginning to end. Numerous opportunities will be identified from this event. We welcome the input and participation of a IHI Open School student team to help develop, test, implement, and evaluate change ideas that will lead to an improvement.
Scarborough Hospital (1 QI Project)
Location: Lawrence Ave. & McCowan Rd.
The student team will be working on a project related to medication reconciliation. More details regarding the project are to come.
St. Michael’s Hospital (1 QI Project)
Location: Downtown Toronto
2012-2013 Quality Improvement (QI) Projects
University Health Network (UHN) Telehealth Program
Caterina Masino, Analyst, Telehealth Program
Addressing UHN User Satisfaction with Telehealth
Over the past 10 years, the University Health Network (UHN) Telehealth Program has enabled UHN providers to use videoconferencing to connect with patients. UHN is interested in addressing quality improvement within its Telehealth department, particularly around measuring UHN provider satisfaction with Telehealth. One project option may involve developing, testing and implementing a qualitative survey to different groups of health care providers. The student team may have the opportunity to interview various providers at UHN’s multiple sites, collect their feedback, evaluate results and refine a survey tool.
- Student Team of 4-6 students;
- Preferred meeting times – TBD with project team
Providence Healthcare Centre
Heidi Hunter, QI Manager
Providence Healthcare Centre would like to plan, develop and test a quality improvement educational program. Work done to date has been identifying the key areas for education. The scope of this project would build on previous work and would include actually developing the learning modules through collaboration with staff, external review, as well as, determining the best medium for communication. Content and medium could be put through PDSA cycles and a small group of staff would be involved in running the cycles as well.
- Student Team of 4-6 students;
- Appropriate immunizations; and
- Preferred meeting times – Mondays 8:30 a.m. – 12:00 p.m.; Friday 8:30 a.m. – 12:00 p.m.
Southeast Family Health Team
Addressing no-shows in family health team clinic – This project seeks to address the concern of no-shows in the family health team clinic. The student team will begin by determining the cause of no-shows by consulting literature, utilizing Patient Records, staff input and sampling patients. Once the cause of the no-shows has been determined, the team will implement some changes and test whether these changes reduce the number of no-shows.
- 3-4 student team
- No immunizations required;
- Preferred meeting time: Tuesday after 2 p.m.; Wednesday anytime
- Any onsite work will need to be conducted between 8:00 a.m. and 8:00 p.m.
The Scarborough Hospital
Alfred Ng, Director, Innovation and Performance Improvement Office, Clinical Operations Support
The following are two potential projects to be considered:
1. Developing and conduct an evaluation plan for TSH’s Lean Management Program
“Business Performance System” – Most acute care hospitals have centralized support for large scale quailty improvement initiatives. The Scarborough Hospital has sought to develop a “Lean Management Program” – called the Business Performance System, that aims to develop a culture where clinicians and front line staff are empowered and resourced to create daily improvements to their work life. This project seeks to design an evaluation plan to measure the success of the Business Performance System program at the Scarborough Hospital.
2. Developing process for collecting patient feedback
There is currently no formalized process for taking patient feedback and using it as a positive input for quality improvement. This project would involve designing a process to manage patient feedback. Students will have to determine what the measures for success are and will work together with internal stakeholders to define the objectives of this process.
- Student team of 4-6 students;
- Appropriate immunizations; and
- Preferred meeting times – Tuesday 2-3 pm; Thursday 1-2 pm
St. Joseph’s Healthcare Centre
Ivan Yuen, QI Manager
The following are two potential project ideas:
1. Contributing to the Building Genuine Partnerships Corporate Initiative
This project will focus on improving one aspect of this corporate initative. The Building Genuine Partnerships Corporate initiative was developed as a response to a staff survey on how well St. Joseph’s is meeting best practices. Based on the survey, some improvement areas were identified, one of which will be addressed by a student team. Selection of this improvement area will be a collective decision by the project champion and student team.
2. Minimizing waste and improving efficiency in the use of emergency department supplies
The Emergency department would like to determine how to minimize waste and improve efficiency with respect to their supplies and materials. A goal of this project is to better meet infection control standards in a small space. This project may benefit from the application of lean principles. Students must be prepared to meet regularly onsite to apply changes and measure improvement.
- Team of 4-5 students;
- Immunization and hospital badge approval for each student; and
- Preferred bi-weekly meeting time with champion – Wednesday (1-2pm); otherwise Wednesday or Thursday (12 pm – 1 pm).
Trillium Healthcare Centre
The following are two potential projects to be considered (or could be done together):
1. Developing a discharge envelope to reduce avoidable readmissions
One of Trillium’s key initiatives is to reduce avoidable readmissions by ensuring that patients are properly discharged from the hospital and have all the appropriate information needed to return safely into the community. One way to do this is to create a discharge envelope that patients would receive before leaving the hospital. This project would be to determine what information should be included in the envelope and how it should be structured in order to be feasible to the hospital (given their current technology infrastructure) and understandable to the patients. The student team will conduct a literature review to gather best practices from other hospitals and interview healthcare providers involved in discharging the patient.
2. Improving the quality of follow-up phone calls
Another way to reduce avoidable readmissions is to improve the process and quality of follow-up phone calls to patients that have been discharged from the hospital. In particular, this project seeks to determine what types of questions should be asked to the patient, who should administer the phone call, and who should follow-up with the patient afterwards. Similar to the previous project, this project will involve researching the best practices of other organizations with regards to follow up phone calls and interviewing healthcare providers.
- Student team of 5-6 students;
- Appropriate immunizations; and
- Preferred meeting times – TBD.
Sunnybrook Health Sciences
Ben de Mendonca
Evaluating the impact of Hand Hygiene Compliance program
One of Sunnybrook’s key initiatives is to ensure that all hospital staff adhere to hand hygiene requirements. For physicians, in particular, this is an important component of their clinical practice. This project will evaluate the impact of a recently-developed communication campaign and knowledge strategy for hand hygiene compliance. The student team will be required to determine quantitative and qualitative performance metrics that will best measure impact and penetration of this program throughout the organization and then collect these performance metrics by interviewing and shadowing medical residents and other staff members. Results of the evaluation will be reported back to the steering committee and the student team will also offer their suggestions as to how to improve the program.
- Student team of 5-6 students;
- Interviews with residents may occur in the evenings and weekends, and may occur on U of T campus;
- Preferred meeting times with champion – Flexible.
St. Michael’s Hospital
Dr. Chris Hayes
There are a number of quality improvement initiatives underway at St. Michael’s. The student team will have the opportunity to select a project with the project champion.
Sick Kids Hospital
Michael Hartman, Director, Process Improvement
The following are two potential projects that could be offered at Sick Kids:
1. Organizing operating room supplies for orthopaedic surgery
2. Improving the bone marrow transplant process
Examples of Past Projects
The following are past projects that have been completed by student teams:
Sick Kids (2010-2011)
Increasing communication of patient isolation status among nurses in the hospital. Some interventions included stapling a clip sheet to the primary nurses’ care plan as a reminder to report isolation status at break coverage handovers. Another intervention was adding an isolation status prompt on charge nurses electronic report sheet. The third intervention was a combination of both the clip sheet and the prompt intervention.
Developing a interaction workshop to enhance awareness of patient centered care and patient safety among hospital staff. The workshop had elements of play called “Seeing the forest,” which uses arts to communicate the importance of patient safety, as well as, a interactive discussion session with debrief and reflection.
St. Joseph’s Healthcare Centre (2012-2013)
Testing the effects of implementing an online MRI examination booking system on requisition handling times and procedure wait times at St. Joseph’s Healthcare centre. The student team found that the intervention, online MRI examination booking system, did reduce wait times for certain procedures.