Initiating QI Program Activities

The activities that take place in the months leading to implementing program activities will prepare QI project teams to begin testing interventions using Plan-Do-Study-Act (PDSA) Cycles, submitting monthly electronic health record (EHR) data extracts, and testing tools and resources.

Appendix 2 (Toolkit Resource 2. Graphic on Launching an Improvement Project) provides a detailed view of how to successfully launch a QI project, from creating the Aim to developing the team, clarifying the goal, identifying measures, understanding the current process, determining the intervention, and launching PDSA cycles. 

We recommend the following additional activities to get your practice started:

• Form a core QI team. Prior to starting project activities, gain leadership buy-in! Organizational support is critical to implementing an effective and sustainable quality improvement effort. Teams should be comprised of two practice champions, when possible (a key staff and a key provider champion), key institutional leaders, and supporting interdisciplinary team members such as a medical assistants, nurses, pharmacists, or community health workers. Smaller workgroups may be necessary to address specific Key Drivers, if working on more than one Key Driver at a time (See Key Driver Diagram).

• Develop a process to view real time data. The role of data is critical in any improvement effort. Your practice should establish a method for retrieving and viewing EHR data elements in conjunction with the Project Data Leads. This can be through a formal data pull or a manual simple tracking mechanism. The EHR data will be used to create run and control charts to inform your practice of progress on achieving SMART Aims over time. 
  
  • Data measures are listed in selected areas of the Key Driver sections, where we will have data from our QI dashboard or examples to share and discuss with your practice teams.
• Begin to examine how your practice currently assesses and addresses overall diabetes control and key subgroups. In particular, focus on how your practice ensures patients have A1C tests done and that follow-up visits scheduled monthly until blood glucose is controlled using high level process maps with your assigned QI coaches. Set a disparitiesfocused aim and begin to conduct PDSAs in areas with disparities.

• Review the treatment algorithm and standardized follow-up visit template and consider adapting for your practice to begin using as you work on timely follow-up.

Culture of QI 

As teams study baseline processes, test interventions, review results, and make additional data-driven changes, a culture of QI begins to emerge. Each PDSA cycle requires team members to feel comfortable sharing ideas and presenting different viewpoints. This work depends on a psychologically safe, adaptable environment where teams can learn from failure. Through active listening, team members build trust in both the data and one another’s input, supporting continuous learning and a stronger care delivery system. For more details on establishing and maintaining a continuous improvement culture, visit ahrq.gov/ evidencenow/tools/keydrivers/ nuture-leadership.html.