What is Quality Improvement?
What are PDSA cycles?
Who participates on the WIPHL QI teams?

What is Quality Improvement?
Quality improvement is a practical approach to systems or process change. A growing body of literature shows how QI principles can help create much-needed improvements in a variety of health care situations. Examples include improvements in the care of patients with back pain, hospital mortality associated with coronary artery bypass grafting, the care of patients with pancreatitis, and in improving access to substance abuse treatment.

The goal of "rapid cycle quality improvement" is to allow teams to 1) identify what they want to accomplish 2) develop a measure for evaluating change, and 3) determine a change or an action that a QI team believes will result in an improvement. In the WIPHL project, the clinic QI teams are supported in conducting Plan-Do-Study-Act, PDSA, cycles to test their changes.

What are PDSA cycles?
Plan
• In this step, teams decide what barriers are in the way of meeting their measurable goal. An example might be, Clinic X wants to increase the number of eligible patients who complete the WIPHL brief screen from 76 percent to 90 percent but patients just aren't turning in the completed brief screen.
• Then the team decides on the key steps to accomplishing their goal, decides who is responsible for carrying the actions out, and sets a timeline. One key step might be that receptionists agree to present the brief screen to all eligible patients as a routine part of clinic practice and give explicit instructions about who to turn the brief screen in to when they have completed it.

Do
• Communicate the plan of action.
• In this step, the responsible parties implement the chosen action, collect simple data on the results of the action, and begin an analysis of the data. An example of this could be, at Clinic X receptionists hand the form to all eligible patients and say, "Please make sure to fill out this form while you are waiting for your appointment and return it to the person who takes you back to your room."

Study
• Solicit feedback.
• As a team examine the data and the feedback about this action. Continue to analyze the data. What are the numbers telling us? What are people's reactions to the change? Summarize what was learned.

Act
Adopt the planned action, Amend the planned action, Abolish the planned action.
• At the end of a PDSA cycle, analyze the data. Did the planned change result in the intended outcome? Was there movement in a positive direction that minor adjustments in the plan could improve? Did the change make things worse?
• Decide to adopt the change, amend the change, or abolish the change.
• Communicate the outcome and continue into the next PDSA cycle.


Who participates on the WIPHL QI teams?
Each clinic is unique and each WIPHL QI team has a somewhat different composition. As a general rule of thumb, it is helpful to include representation from each area of the clinic that is impacted by WIPHL programming. One thing that is consistent is that each team has a clinic champion, a clinic co-facilitator, a QI co-facilitator, and a health educator.

Clinic Champion: The clinic champion is someone who is able to champion the project in the clinic. This person should have insight into the clinic culture and be able to influence the successful implementation of WIPHL initiatives.

Clinic Co-Facilitator: This person should be someone at the clinic who has the time and skills to dedicate to co-facilitating the monthly WIPHL implementation team meetings and help manage the successful implementation of PDSA cycles.

QI Co-Facilitator: This person is either a staff member of the clinic or an outside consultant who is paid by the WIPHL grant to provide technical assistance with WIPHL quality improvement efforts. This person is responsible for co-facilitating monthly implementation team meetings, documenting PDSA cycles, and providing technical assistance to implementation team members, and communicating with the WIPHL project manager about implementation plans, barriers, strategies, and best practices.

Health Educator: The health educator is responsible for delivering WIPHL services, reporting data to the WIPHL central team on a weekly basis, helping to communicate needs/ barriers and successes to the rest of the team and clinic.