DHM Quality Post - Sept 2021
thequalitypost
Greetings from Cat, Saj, Ari and Jenica
Welcome to the 126th edition of The Quality Post! In this issue, we provide updates on the length of stay improvement work, offer an Individual Provider Dashboard tip, and introduce our new FY22 True North Quality Metrics.
inthisissue
Transitions in the DHM QI Leadership Team
Model Kindness on Your Team
Length of Stay Improvement Work Updates
Individual Provider Dashboard Tip
FY22 DHM True North Quality Metric Performance
Transitions in DHM QI Leadership Team
As I write this, my last cover piece for the Quality Post newsletter as the DHM QI Director, I am experiencing a swirl of emotions. Enormous gratitude for all of the amazing and deeply talented inter-professional team members I have had the privilege to partner with over the years. Sadness about this chapter of my professional life coming to a close. Confidence that Saj Patel, in his new role as the QI Director, will take the program to even greater heights alongside the future Assistant QI Director, Jenica Cimino (QI Program Manager), Ari Hoffman (Director of Value Improvement), Erin Yao-Cohen (Director of Patient Experience), Andy Lai (Director of Case Review), and Armond Esmaili (Medical Director of the Medicine Unit-Based Leadership Team). There is also a sense of relief that I will have more time to focus on other professional opportunities in the near future.
I don't want to make this final cover piece all about me and my emotions though. What I will share is that our QI work has always been about more than one individual, team, or unit. The heart of our work has always been the patients we have the privilege to serve. Although there will likely be changes to how QI is operationalized in our Division (and I greatly welcome those changes!), I know that the WHY behind our QI work will not change.
Moving forward, I feel energized by the continued opportunities to improve the clinical care we deliver and the systems that we deliver it in for our patients. I look forward to working alongside all of you, not as the QI Director, but as someone who remains a QI enthusiast at heart.
Model Kindness on Your Team
The benefits of kindness at work are well documented. But how do you actually promote caring and generosity on your team?
First, take the lead. People are highly attuned to the behaviors of high-status team members; when you give recognition to your colleagues, they're likely to emulate your behavior. Second, set aside time during Zoom meetings for a "kindness round," in which team members are free to acknowledge and praise each other's work. This doesn't need to take up much time -- even just a few minutes is plenty of time to boost morale and social connection.
Finally, consider small, peer-nominated spot rewards to allow people to recognize their colleagues' work. If you have a limited budget, a gift card or a small gift can show appreciation that goes a long way. It's your job as a leader to set a tone of kindness on your team. These small gestures can have a big impact.
This tip is adapted from “Don't Underestimate the Power of Kindness at Work” by Ovul Sezer et al.
Length of Stay Improvement Work Updates
Hospital throughput and length of stay (LOS) is admittedly not always the most exciting improvement opportunity. However, it is incredibly important and ultimately connects back to the patients we serve: reducing length of stay matters for the patient experience. Long waits in the ED and delays in clinical care are frustrations that patients share with us in patient surveys and in our Patient and Family Advisory Council. Patient safety is at risk with longer ED boarding times. Delays in clinical care and ED boarding also profoundly affect our experience as providers, leading to increased burnout. It is also incredibly important for us to ensure hospital beds are accessible for patients who need the tertiary/quaternary care that UCSF can provide.
Since April 2021, our Division has partnered closely with the Health System and the Continuous Improvement Department in a "LOS Sprint" to jump start and reinvigorate hospital throughput and LOS initiatives. This work has since been extended beyond the initial three month scope and will be an ongoing primary focus of our Division, Medicine UBLT, and Health System for this year. The encouraging news is that the hospital medicine average LOS has decreased since the start of the work, and we do not want to lose momentum.
Although LOS improvement can feel daunting and out of the control of individual hospitalists, we know that for us to be successful, we need all of us as individuals to trial new workflows and/or behavior, and we need our health system to also support us in experiments aimed at building more efficient systems. Examples of the health system investing major resources into building better systems for us to deliver patient care include improvements in inpatient MRI to decrease the time it takes for a patient to complete their exam to improvements in inpatient pharmacy to improve the reliability and efficiency of the electronic prior authorization process and Meds2Beds service. The health system has also piloted and launched the inter-disciplinary Adult Flow Coordination Team, who can be a source of contact to escalate throughput and discharge barriers to.
What can you do as an individual hospitalist?
For further information or questions, contact Cat Lau, Armond Esmaili, or Sarah Apgar.
Individual Provider Dashboard Tip
DHM Dashboard Tip #2:
bit.ly/dhmdashboard - bookmark this!
The radar graph on the main screen quickly shows you your normalized data (Yellow) compared to DHM Targets (Blue) – Yellow outside Blue means you’re performing above the DHM Target (also indicated by the Green text), whereas Yellow inside Blue means you’re performing below DHM Targets (also indicated by Red text). The box to
the right shows you how many days on GMS and UCW service you did compared to the median, as well as the average Case Mix Index (ie, complexity) of the patients you cared for.
Please email Logan (Logan.Pierce@ucsf.edu) or Saj (sajan.patel@ucsf.edu) with any questions, and check out the DHM
Wiki Dashboard Page for more info!
