Volume 48, No. 11, November 2022 607
rics, they will annually review outcomes with the institu-
tion's quality team to determine if relevant tracked metrics
were measurably and sustainably improved.
In addition to clinical quality benefits, we also sought to
determine if the ABQI tool fostered frontline HCP engage-
ment. Half of our clinical excellence stories were submitted
by frontline HCPs using the ABQI tool. This is a promis-
ing outcome and suggests that ABQI may provide a viable
pathway to increase frontline HCP engagement. However,
as mentioned previously, one of our key lessons was that
we needed to keep this tool at the top of HCPs' minds as
a quality improvement resource, otherwise referrals dwin-
dled. Previous studies suggest that frontline HCPs disen-
gage from quality improvement efforts when they do not re-
ceive regular feedback from the investigating team.
22
There-
fore, with continued use and sustained organizational com-
munication team partnership, we are hopeful that ABQI
will become permanently incorporated into our organiza-
tion's culture. We have also begun including the ABQI tool
in new employee orientation sessions so that all incoming
HCPs immediately associate the asset-based mindset with
our organization. The long-term impact of our ABQI tool
on frontline HCP engagement will be measured through
our institution's annual employee engagement survey. Ag-
gregated frontline HCP data for the following three ques-
tions will be collated for yearly AIT review: (1) "I know my
contributions are valued at Banner Health"; (2) "How of-
ten are providers in this office open to staff ideas about how
to improve office processes?"; and (3) "Staff are encouraged
to express alternative viewpoints in this office."
For
other institutions planning to launch the ABQI tool,
we suggest adapting the institution's existing AER software.
In our experience, the software vendor readily programmed
Converge Platform to track stories of excellence, as this
workflow was similar to their current adverse event tracking
functions. Adding the ABQI tool's front-end and back-end
components' questions also proved uncomplicated for the
vendor. Therefore, other institutions may similarly refor-
mat our ABQI tool questionnaire into a configuration that
is native to their existing software. Due to our institutional
contract with the vendor, there were no software startup
costs nor additional operating expenses for our ABQI tool,
but other institutions should consider such costs before
implementation. Staffing costs should also be considered
for institutions that compensate team members for quality
improvement–related committee work.
In the future, we plan to expand the ABQI tool into our
organization's acute care facilities, urgent care centers, and
other health care delivery entities. Furthermore, instead of
relying solely on stories reported by frontline staff, the AIT
is planning to explore clinical quality metrics (for exam-
ple, hemoglobin A1C control, mammography screening)
and patient experience feedback surveys to identify high-
performing HCPs. The AIT will then work with these high-
performing HCPs to proliferate the root causes of their suc-
cess. With expanded ABQI tool utilization, future studies
may include cost-effective analyses of our ABQI tool, quan-
titative and qualitative feedback from frontline HCPs and
downstream AIT communication recipients, and detailed
clinical and organizational culture outcomes analyses. By
sharing this ABQI tool, we are confident that other insti-
tutions can adopt this asset-based mentality and transform
quality improvement efforts throughout health care. Ul-
timately, if these ABQI tools prove universally successful,
regulatory agencies and insurers may eventually openly rec-
ognize their value, and health care organizations may then
place just as much emphasis on these asset-based initiatives
as they currently do with deficit-based quality assurance.
Conflicts of Interest. All authors report no conflicts of interest.
Vilert A. Loving, MD, MMM , is Chair, Banner Medical Group, Ambu-
latory Peer Review Committee, and Chief of Breast Imaging, Banner MD
Anderson Cancer Center, Division of Diagnostic Imaging, Gilbert, Arizona
Connell Nolan, MS , is Senior Director of Organizational Development
and Transformation, Department of Organizational Change Management,
Banner Health Marjorie Bessel, MD , is Executive Vice President, Chief
Clinical Officer, Banner Health. Please address correspondence to Vilert
A. Loving, vilert.loving@bannerhealth.com .
REFERENCES
1. Edwards MT . In pursuit of quality and safety: an 8-year study
of clinical peer review best practices in US hospitals. Int J
Qual Health Care. 2018 Oct 1;30:602–607 .
2. The Joint Commission. Home page. Accessed Aug 23,
2022. https://www.jointcommission.org/ .
3. Centers for Medicare & Medicaid Services. Quality
Improvement Organizations. Accessed Aug 23, 2022.
https://www.cms.gov/Medicare/Quality- Initiatives- Patient-
Assessment-Instruments/QualityImprovementOrgs .
4. Landrigan CP , et al. Temporal trends in rates of patient
harm resulting from medical care. N Engl J Med. 2010 Nov
25;363:2124–2134 .
5. Paterick Z , Paterick TE . Peer review—legal and ethical issues
faced by medical staff: the mandate for physician leader-
ship. Hosp Pract Res. 2019;4:76–79 .
6. Lossius MN , et al. Transforming the culture of peer review:
implementation across three departments in an academic
health center. J Patient Saf. 2020 Dec 1;17:e1873–e1878 .
7. Archer S , et al. Development of a theoretical framework
of factors affecting patient safety incident reporting: a
theoretical review of the literature. BMJ Open. 2017 Dec
27;7:e017155 .
8. Edwards MT . Engaging physicians in patient safety
through self-reporting of adverse events. Physician Exec.
2012;38(4):46–48 50, 52 .
9. Kaldjian LC , et al. Reporting medical errors to improve pa-
tient safety: a survey of physicians in teaching hospitals.
Arch Intern Med. 2008 Jan 14;168:40–46 .
10. Harrison R , Lawton R , Stewart K . Doctors' experiences of
adverse events in secondary care: the professional and per-
sonal impact. Clin Med (Lond). 2014;14:585–590 .
11. Wu AW , Steckelberg RC . Medical error, incident investiga-
tion and the second victim: doing better but feeling worse?
BMJ Qual Saf. 2012;21:267–270 .
