Asset-Based Quality Improvement Report & Tip Sheet

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Volume 48, No. 11, November 2022 605 Figure 4: This fishbone diagram illustrates the Appreciative Inquiry Team's brainstorming to determine the root cause of a health care professional's consistently exceptional hypertension management quality metrics. Although typically used during adverse event investigations, root cause analysis tools can also support asset-based quality improvement projects. HCP, health care professional; BP, blood pressure. plicitly detail the clinical best practice. Finally, based on all the above considerations, the ABQI tool probes whether the reviewer believes further resource allocation is warranted to initiate quality improvement projects and/or propagate elu- cidated best practices. Following AIT members' analyses, all stories are dis- cussed at monthly AIT meetings. AIT members share their preliminary thoughts and follow-up suggestions with the multidisciplinary AIT. Because all AIT members had expe- rience with quality improvement projects, most were previ- ously trained to use the medical literature to support follow- up suggestions. The multidisciplinary meetings also rou- tinely emphasize evidence-based best practices for propa- gation. The reported HCPs are always invited to optionally join the AIT meetings. At the conclusion of each story's re- view, the AIT completes the final section of the ABQI tool's back-end component: an action item summary for follow- up. Clinical Vignette The following clinical vignette illustrates the ABQI tool in action. Using the ABQI tool's front-end component, a frontline HCP described a colleague, "Dr. Smith" (not the HCP's real name), who consistently achieved excep- tional hypertension control for her patients. Our institution closely tracks hypertension control not only for its clinical importance but as a quality metric, as it affects financials for our Accountable Care Organization. The submitting HCP felt that Dr. Smith achieved these successful outcomes due to strong leadership and effective teamwork. The AIT believed this story worthy of review to deter- mine the root cause of Dr. Smith's successful outcomes. First, an AIT member accessed the ABQI tool's front-end component to review the submitted story. The AIT mem- ber then interviewed Dr. Smith to determine her routine workflow when encountering hypertensive patients. After the interview, the AIT member accessed the back-end com- ponent of the ABQI tool. Within the tool's back-end com- ponent, the AIT member described the usual clinical ac- tion as follows: "Medical assistant measures the patient's blood pressure soon after registration, using an automated sphygmomanometer. If hypertensive, the medical assistant may recheck blood pressure at the end of the appoint- ment. The physician then prescribes a treatment plan. All of these findings and recommendations are 'usually' doc- umented in the patient's chart on a laptop in the exam room with the patient." Regarding what should happen in an ideal state, the AIT member was inspired by many of Dr. Smith's actions: routine blood pressure rechecks with manual cuffs rather than automated cuffs, rechecking with medical assistants two weeks after the initial appointment to determine treatment effectiveness, and building patient rapport by leaving laptops out of the exam room and main- taining constant eye contact. Dr. Smith intentionally com- pletes all patient charting outside of exam rooms imme- diately following patient appointments. The AIT member further proposed that these procedures were best practices that should be widely propagated throughout the medical group. The multidisciplinary AIT subsequently discussed this story and invited Dr. Smith to further elaborate on her workflow. Potential root causes of excellence were dissected ( Figure 4 ). Based on these brainstorming sessions, the AIT highlighted the following key best practices: (1) using a

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