Jennifer I. Lee, MD, FACP serves as an Assistant Professor of Medicine at Weill Cornell Medical College. Dr. Lee is a recent recipient of the AAMC Learning Health Systems Research Champion Award for her work on the Quality Improvement and Patient Safety (QIPS) committee that has been established at Cornell. In this month’s Member Spotlight, Dr. Lee describes the QIPS committee as a bridge to multidisciplinary and interinstitutional collaboration to build a culture of high value quality care. Download Dr. Lee's ROCC Star profile.
Please describe the purpose and goals of the Quality Improvement and Patient Safety (QIPS) committee at Weill Cornell Medical College.
In 2010, the Department of Medicine at Weill Cornell Medical College formed the Quality Improvement and Patient Safety (QIPS) committee with the mission to focus on proactive efforts to improve the quality and safety of patient care in the hospital and community practices. With representatives from the hospital, nursing and physicians from all clinical divisions, we designed the interdisciplinary structure of our committee to stimulate collaboration through the sharing of ideas for initiatives that are often relevant across divisions and are in alignment with the quality goals of our hospital.
Our members are dedicated to becoming the quality champions for their division, the department and the institution through education and leadership in proactive quality improvement and safety efforts focused on providing high value, cost-conscious care to our patients. Our mission is to promote and foster scholarship through the interdisciplinary and inter-institutional collaboration for quality improvement (QI) education, mentorship, projects, and research.
How was the QIPS program initially able to receive support from different representatives (e.g. nursing) and hospital leadership?
Building and maintaining relationships with hospital leadership and other disciplines were essential for the collaborative work our committee was formed to accomplish. From the outset, we specifically designed our committee to include the hospital’s Division of Quality and Patient Safety, nursing and other disciplines that are fundamental to patient care and our practice. Ensuring alignment of goals and active participation of our committee members in a wide range of clinically relevant quality improvement projects and safety initiatives were some of the steps we took to form and sustain those bonds. Through these ongoing collaborations, we continue to work towards bridging the gap in communications that existed in the past between our department and the hospital and other disciplines.
Please describe what happens at the monthly QIPS meeting and who attends.
While our meetings are open to individuals from all disciplines who are passionate about quality improvement and safety, we do have designated committee members. Our regular members represent the hospital (our Department of Medicine Performance Improvement Specialist), 12 of the main clinical divisions within our department (physicians with both inpatient and outpatient practices), the internal medicine residency and physician assistants programs (chief resident and chief PA), the Unit Medical (physicians) and Patient Care Directors (nurses) of the primary medicine units in the hospital as well as their care coordinators.
Our monthly agenda varies and guest speakers are often invited to present topics pertinent to both the inpatient and outpatient setting. Quarterly updates on performance metrics are included, both those that are of interest to our committee members as well as published data on national metrics. Primers on quality improvement methodology and patient safety science are also included among our monthly topics. Our meetings also provide a venue for key points from other hospital and division quality meetings to be presented and discussed.
All meeting agenda items are presented at the division level by our committee members to ensure department-wide awareness.
Please describe how the QIPS program is often the first opportunity for funding for those who have a research interest in QI but may not be on a traditional clinical research track.
While gaining momentum, achieving scholarship in quality improvement has traditionally been challenging. Not all quality improvement initiatives lead to research but we believe the former are no less important, can be very labor intensive and time consuming, and often remain unrecognized. In addition, about half of proposals submitted every year are from junior faculty without previous research experience or training in QI science. Many internal funding opportunities are offered as supplements to larger grants or awarded based on the project’s ability to receive outside funding when complete. Focus often remains on the paradigm of traditional clinical and translational research methodologies which may not fit with quality improvement. While organizations such as PCORI and AHRQ do provide awards for QI, the majority of the grassroots projects our residents and faculty design start smaller in scale and require assistance to develop and implement to reach the next level.
The QIPS QI project award recognizes these challenges and provides promising projects with potential for sustainability and dissemination the necessary funds and support required to ensure that the final outcome can meet the standards needed for success.
What does the mentorship network look like? Who is involved? What are the goals for all parties involved?
While our Director of QI operations and research assistant have provided support to all winning projects in the past, this will be the first year that we will be implementing a formal mentor network for each awarded project team. In addition to the research assistant who will assist in IRB preparations and logistical support, the mentor team will also include faculty with experience in QI methodology, research science, and statistics. QIPS committee members and past awardees serve as part of this team. There will also be a member from our hospital’s Division of Quality on each team to support project development and implementation in our efforts to ensure sustainability.
The goal of the mentor network is to assist the project team in the successful implementation of their project. Together, we will work to (1) ensure the validity and rigor of the project design and metrics; (2) identify and design strategies to overcome challenges encountered during the implementation process; (3) collaborate with key stakeholders to ensure sustainability; (4) promote QI scholarship through presentations and publications; (5) grow our mentor network through the training of each subsequent group of awardees.
Please describe 1-2 projects that were reviewed by the QIPS committee and ultimately funding for the coming 2015 year.
To date, the QIPS committee has funded 25 projects. Now in its third year, we have decided to dedicate our resources to five or six projects which our interdisciplinary review committee (QIPS committee members, past awardees, hospital and nursing leadership) felt had the highest potential for sustainability and scholarship. One project focuses on defining the clinical and economic Impact of a new rapid molecular diagnostic test for bloodstream infections soon to be launched at our hospital. Another project which spans both the inpatient and outpatient settings will develop a diabetes discharge regimen using a transition algorithm and care program developed with our hospital to manage adult diabetes and assess its impact on reducing readmissions.
Please describe the metrics that have been established for evaluated the success and value of the QIPS program.
The purpose of the QIPS fund is to both stimulate quality improvement and provide mentorship and support for non-research faculty and house staff in QI projects and research. To achieve these goals, we have formulated two metrics:
- Did the project lead to changes in clinical policies or procedures so that it is sustainable?
- Did the project lead to a scholarly product, defined as a presentation at a national meeting and/or publication in the peer-reviewed literature?
With regard to the first metric, 25 QIPS projects have been funded since the program began in 2012. Of these 12 projects led to changes in practice and/or policies. At least eight are being continued after the projects were completed. With regard to the second metric, eight projects were presented at national meetings, five of which were funded in 2013 and are currently being prepared as manuscripts for publication.