Asset-Based Quality Improvement Report & Tip Sheet

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606 Vilert A. Loving, MD, MMM, et al. An Asset-Based Quality Improvement Tool for Health Care Organizations manual sphygmomanometer to confirm readings from an automated sphygmomanometer; (2) employing visual cues to alert attending HCPs of patients with high blood pres- sure readings that required action planning; (3) eliminat- ing laptops in exam rooms to foster rapport and treatment compliance with patients; and (4) multiple blood pressure rechecks to gauge treatment effectiveness, including medi- cal assistant appointments between visits, which require no additional copayments. Through internal electronic com- munications and medical group leadership updates, the AIT shared these best practices and inspired other outpa- tient health centers to launch quality improvement projects emulating these practices. RESULTS AND LESSONS As a pilot project in its first year of use, from January through December 2021, the AIT received 26 ABQI sto- ries. Of these 26 stories, 3 were worth sharing for potential systemwide quality improvement initiatives, and 5 were sto- ries of clinical excellence that the AIT disseminated to in- spire practice improvement among other HCPs. Therefore, a total of 8 stories (30.8%) resulted in replicable best prac- tices or actionable quality improvement projects that were shared organizationwide. Examples of projects and practices collected by the AIT include workflows to decrease pedi- atric vaccine waste, electronic medical record templates that increase HCP efficiency and serve as clinical history-taking checklists for complex diseases, and open-ended question- ing techniques to promote efficient and effective patient interactions. In addition, 13 (50.0%) stories were submit- ted by frontline HCPs, with the remainder submitted by administrators describing frontline HCPs at their specific health center locations. Ultimately, at the end of its first pi- lot year, the AIT project achieved its baseline target goals. One of the lessons that we learned is that frontline HCPs require constant reminders of quality improvement tools' availability and benefits. Most story submissions immedi- ately followed organizationwide communications from the AIT. For example, following the initial launch communica- tions, multiple stories were submitted. Story submissions subsequently slowed over the next month, until the first round of best practices was shared organizationwide. Then the AIT received another batch of stories. Close collabora- tions with the internal communications team proved criti- cal to keep this project's availability and quality improve- ment goals at the top of mind for organizational HCPs and employees. To this end, the AIT now includes com- munications team members in the monthly AIT meetings, thus continuously generating dialogues regarding effective communications strategies and releasing monthly medical group updates. Another pitfall is frontline HCPs' limited time for non- clinical data entry. Cognizant of this time limitation, we attempted to streamline the front-end component of the ABQI tool with few questions, most of which required quick single-click responses. However, we ultimately could not avoid open-ended text for the story description. As a re- sult, we encountered several overly brief story descriptions that made it difficult to discern if the stories were worth- while for AIT review. In these scenarios, AIT leads remained open-minded and carefully considered whether best prac- tices could be surfaced, despite the curt descriptions. For example, one story described how patient flows "don't run as smooth when ["HCP X"] is gone!" At first glance, this story may be dismissed as a simple accolade. However, the AIT opted to contact the HCP to thoroughly investigate the processes and workflow efficiencies underlying this ac- colade. The AIT leads now routinely pause and give all submitted stories a second thought before dismissing them from review. Also, in all frontline communications, the AIT now reemphasizes its process- and outcome-improvement goals with the ABQI tool, and these communications in- clude multiple sample scenarios to promote HCP under- standing. Finally, a future challenge may be unintended conse- quences of propagated workflow practices. For example, in the previously described clinical vignette, some HCPs may find that their efficiency or note-taking accuracy are hindered if their laptops are not used in exam rooms. To counter such consequences, in all communications, the AIT encourages feedback from HCPs to stimulate dialogues and iterative improvements. In addition, the AIT empha- sizes that shared best practices are not meant to be pre- scriptive, as each health center likely has nuanced work- flows. Instead, HCPs are encouraged to consider these best practices and adapt them into practice workflows however appropriate. SUMMARY AND NEXT STEPS Our ABQI tool represents an attempt to purposefully in- corporate asset-based methods into organizationwide qual- ity and safety improvement operations. To be clear, our goal was not to replace DBQI methods, such as peer review and incident reporting. Rather, ABQI complements DBQI by providing an additional route to identify best practices and quality improvement initiatives worthy of resource alloca- tion for further dissemination. Our ABQI tool proved lo- gistically and technologically feasible for organizationwide utilization. Although the results are preliminary, this tool successfully exposed value-added best practices and quality improvements that were circulated throughout the medical group. Over the long term, the impact of our ABQI tool on quality improvement will be determined through out- comes measures. As part of an Accountable Care Organiza- tion, our institution tracks key quality metrics, such as hy- pertension management, cancer screening adherence, and tobacco cessation intervention. When the AIT propagates systemwide quality improvements that affect tracked met-

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