discuss high-impact quality improvement projects. Gerard, the floor is yours. Thank you. So I am going to start off with a polling question. Do you have an established QI program and, this is the and, a QI strategic plan? Yes, no, I don't know. Okay, very interesting. We've almost got a split three ways. So, as you've heard in this course, quality improvement just isn't lip service. You really need to pay attention for those programs to work. The importance of quality really needs to be embedded into your facility's culture from the very start, as we heard from Mary Rose and Shanshan. An effective QI program really needs to align your QI initiatives and projects to your overall strategic plan. You really have to have a strategic plan that sets up priority areas and goals and measures the important metrics and resulting changes. It creates processes and procedures that support your QI efforts. This probably means that you have an established QI team, and it could involve various projects. You're holding regular QI meetings. You're making your reporting of QI efforts open and transparent to your staff, to your physicians, and even to your patients. So, a well-established QI program is a basic requirement for a high-performing endoscopy unit. This program must systematically collect and analyze data, identify, monitor, and evaluate the equity, quality, and safety of care delivered, and plan interventions as needed based on the overall strategic initiative. This figure encapsulates a number of examples of performance measures for endoscopy services that focus on quality improvement from leadership and organizational structure, to facilities and equipment, to quality and safety metrics, to clinical appropriateness, consent and care processes, patient aspects, staffing issues and training, and patient feedback. These all form the basis to enact a high-impact quality improvement project. So, why is it important to have a high-impact quality improvement project? These are critical because they drive improved safety and outcomes for patients, improved workflow and efficiency of staff, and lead to less waste due to process failures. Now, more than ever, government and insurance reimbursements for patient care are based on health outcomes, value-based care, rather than procedures undertaken. Think back to the GI Care MVP I mentioned before. Okay, now we have another polling question. Which of the following do you consider a high-impact quality improvement project? A, improving the ADRs of all endoscopists to greater than 30%? B, reducing the no-show rates for open-access colonoscopies to less than 3%? C, improving turnover time to less than five minutes between procedures? Or D, reducing the number of pathology specimen identification errors to 0%? Well, very interesting, right? So, it's really in the eye of the beholder, right? What is a high-impact project depends on who's looking at it. Obviously, each of these projects can be high-impact. So, when developing or planning to develop a high-impact quality improvement project, it's really imperative to identify critical areas of importance that align with the overall strategic QI plan and accreditation requirements. So, here are my tips for developing such a QI project. Really set targets aimed at improving improvements in these four categories, safety, effectiveness, access, patient-centeredness. And as mentioned before by Mary Rose, obtain input from everyone on your team. Look back at that figure on performance measures for endoscopy units I showed you earlier. You may uncover barriers to care, such as transportation issues or management issues, such as long patient wait times. Here is a figure evaluating potential areas of improvement from the referral stage all the way to the follow-up stage. You can see multiple areas that can be focused on and improved upon. Developing, reviewing, and updating protocols and standard operating procedures can be a focus of QI projects in each of these areas. So, this gives you an opportunity to look at every step of the way to look for improvement. My other suggestions include copycatting. See what others are doing. You just saw some great examples from Johns Hopkins about how they established a better efficiency with their unit. And so, great ideas and best practices are ripe for imitation at your own facility. And often, you don't have to reinvent the wheel. There are also great resources from the ASGE available to you, from the Endoscopy Unit Recognition Program website, which has several quality improvement projects listed. Some of you may be aware that in 2024, the ASGE will be awarding EQUIP prizes. Now, you've seen us spell this EQUIP a little bit differently. You saw the title of our course was spelled with a capital Q and a capital I in the EQUIP. So, what does that mean? So, that means endoscopy quality improvement projects. So, these EQUIP prizes are going to be awarded to outstanding DDW abstracts that are focused on QI projects. I hope Johns Hopkins plans on submitting theirs for DDW if they haven't already. So, there's a way to actually look at what high-impact QI projects are being done elsewhere and utilizing them for your own unit. Use the ASGE Practical Solutions Newsletter to give you some ideas. And then, of course, literature reviews. I'm going to show you some examples of what literature review can do for you. I previously showed you information on how to improve adenome detection rate in my last talk. Two of the proven ways to improve ADR are report cards and having an additional observer. I mentioned psychological safety as part of your team with having a nurse and or technician helping the endoscopist identify polyps. Here's another example on proving turnover times using a technique called Fishbone Diagram or Ishikawa Diagram as a visual way to look at the causes and effect to help identify areas for improvement. I don't know if Johns Hopkins did this, but I encourage you to consider this technique when getting team input on problem solving. Make sure your QI projects align to the SMART-E framework I discussed. This stands for Specific, Achievable, Measurable, Realistic, Time-bound, Inclusive, and Equitable. Make sure everyone is a stakeholder. High-impact QI projects use the nuts and bolts of all QI projects. The PDSA framework process is a template in which you can develop QI projects. As Mary Rose had mentioned, making sure that there's an executive sponsor who can help the team overcome barriers to change and secure needed resources is really important. Team members need to include the leader who oversees the project and reports to management, the facilitator who owns the team process, process owners who are knowledgeable about the specific workflow addressed and can assist in the implementation of changes, and the executive sponsor. Outside of the project team, the long-term success of a high-impact QI project depends on the institutional workplace being aware of the identified performance gap, being receptive to the change, and ideally experience in terms of similar efforts. You really want to prioritize projects that are going to give you the best bang for your buck, give you small, easy wins that are worth the effort, and then those that are best saved for last. How disruptive the quality improvement project will be. Think amount of time, resources, and energy. Those should factor in on what you pursue, and the impact on your strategic plan and goals is the other variable. Monitor and reporting are important in developing incremental adjustments to the interventions, and re-measurement of outcomes are repeated, an approach generally that's referred to as continuous QI. Some of the pitfalls that teams often succumb to when developing a high-impact QI project include the following. Lack of executive sponsor or project leader, poor process planning and implementation, and insufficient monitoring and follow-up. So when things aren't working, the team leader, facilitator, process owners, and the executive sponsor really need to act quickly, and when a high-impact QI project is successful, celebrate it. This leads to strong institutional and personal motivation to accomplish other projects. So there is a saying in the QI circles, in quality improvement, people who do the work need to be the ones to change the work. So go get those five-star high-impact QI projects. Thanks for listening.

high-impact quality improvement projects

healthcare facilities

QI initiatives

strategic plans

literature reviews