How to survive ‘quality improvement’

Ugh. Did you get chosen for a “quality improvement” (QI) project by your college of physicians and surgeons?Me too. Here are my take home lessons:1. When you get the notice, click ASAP. They only allot a certain number of completion spots per month. If you leave it too late, all the later slots will be used up, and you’ll be stuck rushing through your “quality” assessment.2. Do you pay the Ontario Medical Association thousands of dollars a year? Now is the time to use your membership! They have people whose job it is to help you complete this thing! And they’re very nice. Don’t be afraid to make an appointment. They have courses, too.One cautionary note: they get paid to counsel you on this. So after a certain point, you need to draw the line on how much energy you want/need to spend on this QI.Other provinces, do your associations help you too? Or maybe you’re lucky enough to escape the QI monster.3. Dive in. There are three parts to the QI, like a bunch of Russian matryoshka nesting dolls all lecturing you about quality and, paradoxically, wellness.Read: Dr. Melissa Yuan-Innes: The case of the kidney killersBefore you even start, my note from the College of Physicians and Surgeons of Ontario (CPSO) said:“Please note the CPSO will not have access to your reflective exercises, only the Practice Improvement Plan will be accessible by the CPSO when it has been formally submitted.”That’s right, most of these nesting dolls are for your own good and your patients’ well-being, not because Big Brother actually wants to read any of your thoughts.I heard of people who spend hours revamping their hospital’s chaotic systems as part of this QI. Up to you, but that’s not required. I’ll say it right here and now, part 3 is the only homework you’ll be officially turning into the college. The rest appears mandatory but not graded.Every time they ask, don’t forget to generate a pdf and SAVE (two separate steps) or you won’t get credit for that nesting doll.Part 1: Survey. Watch a bunch of videos so you can see what makes you high risk for complaints, including stuff you can’t change like your age. You will generate your own risk profile, but don’t worry, the CPSO won’t look at it.Part 2: ‘Activities.’ Warning! This is a separate site with more matryoshka nesting dolls, including a chart review. After you finish this, come back to the original website to finish part 3.For this, I recommend that you pick something quantifiable and do a chart review. I picked “entering patients’ medications.” Sounds simple, right? I originally thought they scanned the patient meds when we got a paper list. Apparently, this takes too much data for storage, and they’d rather doctors spent time entering it manually. Time to check how assiduously I entered the data!I reviewed my charts, and as suggested by my OMA friend, I kept track of the EMR record numbers just in case the college asked me later.Now you fill out the chart review form, which is simple.Then reflect on it, which means filling out more boxes.I was more puzzled by the data-driven quality improvement (DDQI) tool section. Basically, they want you to either observe your practice or pull-out data like “How often do I screen a hemoglobin A1C?” and then reflect on that.When I went online, people were talking about two SMART goals. I saw nothing for the DDQI. Why? Because I was locked in the separate webpage of part 2. It had been so long since I’d done part 1, I had legit forgotten that anything like part 3 existed.I quickly finished up the DDQI so I could move onto part 3, the real meat and potatoes, but when I double checked, the DDQI was still marked as only 50% complete. Why? Don’t forget, generate the pdf and save.Part 3: Practice Improvement Plan (PIP). Back at the home ranch. OK! This is the part the CPSO will actually look at. If you were waiting to call the OMA, call them now.Tips: you need two SMART (Specific, Measurable, Achievable, Relevant, and Time-Bound) goals. Pick ones that work for you, including self-care!I picked record keeping (those medication lists) and meditation. I have always meant to meditate, but I don’t generally do it, even if it’s supposed to make me 10% happier. Trying meditation certainly makes me 10% happier than trying to revamp the hospital’s sepsis triage module! This section is all drop down menus and short answer stuff. Not too onerous, if you know where to look and don’t set your ambitions too high.Physician groups online mentioned a “QI Coach,” but overall, it sounds like it’s unusual for someone to follow up on your Practice Improvement Plan. Which means you spend hours and hours on this, but I imagine the QI coaches usually consider your report satisfactory. Otherwise, you either have to rewrite your report or attend a QI course. Wish me luck.That said, I wish someone had explained all this to me when I started out and saved me some precious time. This is my attempt to pay it forward.QI isn’t such a big deal if you can just ask someone, “Hey, this looks like a pain in the bum. How do you do it?” With the loss of our doctors’ lounges, increased virtual care, in-fighting amongst specialties, the possibility that we’re working in solo practice (another factor for complaints!), and general degradation of our medical system, we can’t tap each other’s shoulders as easily. The Medical Post and online groups can help counteract this a bit. If you work in another province or country, please enlighten us about your college’s mandatory educational modules in the comments. At least two addictions medicine specialists said they had an extremely onerous exam every and to three years, and CPSO was a breeze in comparison!I also think this is preferable (and I’m sure less expensive) than paying a college doctor to come to your site to examine your records.What do you think?

How to survive ‘quality improvement’

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