Getting Their ACT Together

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 Quality Improvement Goes Across Disciplines

This group of Hopkins healthcare professionals—(from left) Casey Humbyrd, MD; Nasreen Bahreman; Paula Justice, RN; and S.R. Khandker, MD—is one of three interdisciplinary teams learning to work together for hospital quality improvement.

by Meredith Lidard

Hopkins knows that quality patient care is an interdisciplinary effort. That’s why the Schools of Nursing and Medicine and The Johns Hopkins Hospital (JHH) have designed a program for new healthcare professionals to work together to improve the patient experience—one recommendation at a time.

The Achieving Competence Today (ACT) program brings together healthcare professionals from a variety of backgrounds to help develop solutions and gain a better sense of how to think about healthcare problems using a systems and quality approach. Originally funded by the Robert Wood Johnson Foundation in 2005, today’s ACT program is sponsored by the Evelyn and Donald Spiro Foundation.

“This is an interprofessional education in a real-life environment,” says Julie Stanik-Hutt, PhD, ACNP, co-director of the program. She says that participants receive pragmatic experience working on real problems that have been identified by units within the hospital. “It is not only a learning opportunity but is valuable to the hospital because real problems get addressed and in a timely manner.”

For five weeks the team members—graduate nurses, medical residents, unit nurses, and administrative residents and fellows—learned about organizational systems issues and how to use quality-improvement tools to transform patient care. Faculty preceptors acted as mentors to further develop and refine their projects.

“It’s always easy to see the problems, but finding solutions that can potentially make a difference and are easily imple-mented is challenging,” says Nasreen Bahreman, a graduate student and research coordinator at the School of Nursing and a nurse at JHH.

Bahreman’s interdisciplinary team was one of three that conducted quality-improvement assessments at JHH. Her group studied the inefficiencies of orthopedic consults in the hospital’s Emergency Department (ED); the other teams examined workflow for radiation treatments and incidence of falls related to toileting.

After reviewing patient-satisfaction surveys and surveying members of the ED team, they discovered that the ED treated an average of 111 acute injury patients per month. Each month, however, another 20 patients left the ED without being treated. Bahreman’s team recommended implementing a three-phase proposal that could reduce the length of each patient’s stay by one hour, freeing up 111 hours per month to treat 10 additional patients. Implementing the proposal would also earn back the lost revenue from walkout patients.

The three teams presented their proposals in April before a panel of judges composed of faculty and leadership from JHH and the Schools of Nursing and Medicine. Bahreman’s team earned first place and received $5,000 to implement their recommendations.

For Bahreman, flexibility was key during the project. “Working in healthcare is becoming more interdisciplinary in nature. I learned to be flexible and at times had to adjust my expectations of how I envisioned the process should work,” Bahreman explains.

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