Decision-Making and Quality Improvement at the Front Line
Abram Gutscher, Program Manager, Integrated Home Care, Alberta Health Services (AHS). In collaboration with six AHS Calgary Zone Integrated Home Care teams and supported by Alberta Improvement Way Process consultants.
Home Care (HC) nursing and allied health staff are highly trained professionals that play an essential role in the quality and safety of care delivered to clients. However, mechanisms for HC staff involvement in quality improvement work were limited. This innovation project tested the ability of these staff members to actively participate in formalized quality improvement initiatives. Specific evaluation questions included: can HC staff members successfully lead QI initiatives; will staff be engaged in a QI role; and what supports and barriers will they encounter?
Although the use of QI is widespread in healthcare, involving frontline staff in all steps in the QI process from project identification to spread was novel for the Integrated Home Care program.
Data-driven quality improvement initiatives led by home care staff have the potential to enhance services for clients in a number of ways including: improved quality and safety of client care; increased time spent with clients; and reduced client deferrals. This project designed and piloted a quality improvement process that enabled front line home care staff to use information generated from data to inform short quality improvement cycles.
The project designed and piloted a quality improvement process to enable Home Care staff members to use information generated from data to inform short quality improvement (QI) projects.
Six quality improvement (QI) projects from six different Calgary Zone Integrated Home Care teams were undertaken. In each project, front line staff identified and selected their QI project, received the necessary knowledge and tools to conduct the project and developed data-driven dashboards to support their decision making. The projects were evaluated and a QI process (framework) for front line staff was developed.
11 recommendations were identified, based on the results of the evaluation. These were used to inform a process within Integrated Home Care for ongoing involvement of staff in quality improvement. A more generalizable ‘Quality Improvement at the Frontline’ toolkit was also created to support the development of a similar approach within other Continuing Care contexts.
Impact and Ultimate Success
The results of the project clearly indicate that staff members can and want to successfully participate in QI work. The 6 pilot projects primarily had an impact on new clinical and administrative practices to improve efficiency and or effectiveness. However, QI projects could be initiated to create improvement in policy, practice, behaviours, services and quality of life.
The major mechanism for sustainability is the implementation of the process within Integrated Home Care for ongoing involvement of staff in quality improvement. This process has been endorsed by the leadership in Integrated Home Care and the program has and continues to take steps towards frontline staff involvement in quality improvement.