Ulfat Shaikh, M.D., remembers a day when she was saying goodbye to her son in first grade. “I just nonchalantly in that motherly way turned to him and said, ‘Have fun in school.’ And then he turned to me and said, ‘Have fun at work.’ That stuck with me.”
The pediatrician at UC Davis Children’s Hospital and medical director of health care quality at the University of California Davis Health says it was a reminder of the reason why clinicians go to work every day: to do good by their patients and derive satisfaction from their work.
“Having an improver’s mindset and looking at things from a glass-half-full perspective helps you do that,” she says. Here, she discusses moving forward the next generation of quality improvement.
Why engage clinicians and caregivers in quality improvement?
There are good data to show that half of our quality improvement efforts failed to achieve their intended outcomes. And a key reason is we don’t engage the clinician who can provide insights into system problems, identify variation in care and identify opportunities for improvement. Half of that group hasn’t been substantially engaged in these efforts. There are data to show that once that’s done, we can work together to improve our pathways of care.
What does that development look like?
We must support dedicated time for quality improvement and building career pathways. We must also recruit clinicians into these career pathways, help them develop a quality improvement mind-set, and mentor young clinicians. We must give them the ability to select areas for improvement within reason.
Provide clinicians with a menu of high-priority areas, and then let them use their intrinsic motivation to create ways to improve. And then finally, organizational support is needed for quality improvement—helping clinicians get data for improvement and providing support and analysis is key.
Tell us about the ‘improver’s mindset.’
When I finished my residency training and was working in a busy outpatient clinic, I noticed patients were spending a large amount of time waiting for services. They waited in the waiting room for care. They waited for lab tests to arrive by mail. They waited for us to communicate key decisions to them.
To look for areas of improvement, I diagrammed the path of a few of our patients from the time they entered our clinic to the time they exited. We must develop that kind of thinking not only in ourselves, but in the younger generation of clinicians who we are training.