Right Care Transformations: 90 Day Rapid Cycle Improvement Exemplars

Diana R. Jolles

Diana R. Jolles

Background

Well intended healthcare systems struggle with how to transform delivery models around right care principles; crippled by inertia and barriers to change. The following panel presentation explores how three diverse and independent health care systems implemented “Right Care” process improvement projects using Rapid Cycle Improvement methods to increase access to appropriate use, while decreasing overuse and misuse of harmful practices. All three projects leverage patient and team engagement to mobilize process improvement to achieve population health outcomes within a 90 day period. Population health issues including sexual orientation, gender identity and disparities; depression screening and treatment within a multi-cultural immigrant clinic and infant feeding practices in the antenatal and postnatal period were identified as urgent gaps within the respective communities.

Methods

Three advanced practice, quality improvement leaders used the Institute for Healthcare Improvement, Model for Improvement and Rapid Cycle Improvement Methodology to plan, implement and evaluate person centered process improvement across three diverse practice settings. The improvement projects occurred in a student health center within an academic institution in New York City, at a Federally Qualified Health Center in Harrisonburg, Virginia and within both an inpatient and outpatient community based setting in western New York.

After a 90 day planning phase involving a variety of baseline data collection techniques, each site underwent 4- two week Plan-Do-Study-Act Cycles. Each project included a panel of 10 measures including process, outcome and balancing measures plotted every 3 days on statistical control charts. In addition, surveys, focus groups and iterative techniques were used to modify interventions as they were brought to spread and scale.

Results

Exemplar 1 The first panelist presents a right care transformation surrounding sexual orientation and gender identification (SOGI) in a student health center in New York City. Decreasing the under-use of effective screening and treatment while improving effective care, this team was able to increase appropriate SOGI recognition and care by to 75%, achieving right care while addressing health disparities among gender minority clients.

Exemplar 2 The second panelist explores improving effective depression screening and follow up for depression in a Federally Qualified Health Center in Harrisonburg, Virginia. Upon initiation of standardized, culturally appropriate screening, depression rates were demonstrated to be as high as 45%. Using the right care framework, provision of evidence based care increased to 71.4% and compliance with follow- up increased by 20% in 90 days.

Exemplar 3 The third panelist presents a successful right care project implemented in upstate New York in a small community hospital to improve breastfeeding exclusivity. Standardization of care to decrease the under-use of effective care practices led to a 16% increase in exclusive breastfeeding on discharge within 90 days. Consumer engagement and standardization of process achieved rapid shifts in outcomes.

Discussion 

A summary of commonalities across the three implementation projects using the right care framework is conducted. Principles of overuse, misuse and under-use are reviewed. Common barriers and facilitators to change across all projects are reviewed.

 

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