The conference room buzzes with conversation. There are no empty chairs in today’s meeting. Instead, the room is crowded with physicians and a handful of staff members and administrators all gathered for one reason — to improve quality and patient safety at UF Health Shands Hospital.
Today, the Physician Director of Quality Committee — comprising physician directors of quality from every department — is discussing, among other things, the quality goals in the new strategic plan for UF Health. They meet every month to discuss important issues related to quality and patient safety and to get on the same page before taking all the new information back to their departments and clinical teams.
Although quality and patient safety are Job 1 for all UF Health physicians — and UF Health as a whole — the physician directors of quality, or PDQs, play a crucial role in these efforts. Think of them as champions for quality in their departments. They serve as the point people to disseminate information about systemwide quality improvement initiatives throughout their departments and help implement best practices, among a slate of other duties. Timothy Flynn, M.D., senior associate dean for medical affairs at the College of Medicine and chief medical officer at UF Health Shands Hospital, devised the idea of having physician directors of quality six years ago and UF Health physicians have served in these roles since then.
“The PDQ’s job is to help get other people involved,” said Anamaria Yeung, M.D., an assistant professor of radiation oncology in the College of Medicine and PDQ for her department. “One of our main goals is to get everyone on the same page about the strategic plan and quality goals for the institution. Once the PDQs have a better understanding, we can bring that back to the departments and help make the goals more tangible for other people doing quality improvement work.”
But up until recently, many of the 29 physician directors of quality had largely been working within their own departmental silos. In part, this is because different departments have specialty-specific needs, so quality improvement information often needs to be tailored to fit within the scope of a department. However, working in silos prevented teams from more effectively collaborating on quality initiatives and resulted in some PDQs becoming well-versed in quality and patient safety while others were less involved.
To help bring the physician directors of quality together more formally, Sharon Byun, M.D., the PDQ for obstetrics and gynecology, and Yeung proposed a change to the then-quarterly meeting held for PDQs to learn about what was happening at the system level. Yeung and Byun suggested the PDQs meet monthly instead and lead the meeting themselves in an effort to better tackle issues crucial to their roles.
“We lacked resources and information about what the job entails. We thought it would be a better and more functional committee if it was run by PDQs and we were able to address issues we were having in common,” Yeung said. “(UF Health Chief Quality Officer) Randy Harmatz supported the idea.”
First on their agenda was getting all physician directors of quality on the same page. As part of this, the committee formalized the job description for PDQs, outlining crucial job duties and qualifications. Also, because some PDQs had outside training in quality and others did not, they participated in University HealthSystem Consortium training in June.
“The primary short-term goals were developing standardization across PDQs so we can communicate in the same language and better coordinate efforts with sound methodology,” said Carolyn Holland, M.D., an assistant professor of emergency medicine in the College of Medicine and PDQ for her department. “Once we get that part smoothed out, it will make it easier to transition into collaborating on projects across departments.”
In addition, one of the organization’s key quality goals is to achieve a five-star rating from the UHC, so ensuring PDQs understand the metrics involved was crucial, Byun said.
“The goal is for each department to utilize a ‘score card’ that contains publicly reported and other internal metrics to guide quality and patient safety improvements,” she said.
Although the changes are helping to standardize the role of the physician director of quality and spark more inventive collaborations, existing collaborations between PDQs and their respective teams have already sparked important quality initiatives.
“We are building an amazing ability to collaborate across departments that did not always exist,” said Eric Rosenberg, M.D., PDQ for the department of medicine and chief of the division of internal medicine in the College of Medicine. “The clinical contacts I have made span every department in the College of Medicine. Prior to the creation of this group, that would not have happened. Now we have relationships so when cases arise or when there is a challenge, I know who to contact and very quickly have a nice liaison to another department. There is also peer mentoring that occurs as we work to solve these quality and safety problems.”
For example, Michele Lossius, M.D., who has served as the physician director of quality for the department of pediatrics since 2013, was inspired to start quality and patient safety rounds in pediatrics after witnessing the practice in the department of anesthesiology. Now the department of emergency medicine has established a similar practice, too.
“I think the PDQs are a motivated group,” Lossius said. “Us being in a position to collaborate together and to be able to say to the institution, ‘These are the needs we see,’ and being able to have a collective voice is instrumental.”
One of the goals of the committee is to establish a real-time repository of quality improvement projects so that everyone can see what teams are working on — making it easier for groups to join forces, Yeung said.
The group also hopes to encourage people to take projects to the next level by contributing to academic quality research.
“We are trying to promote more scholarly activity to come from the group,” said Byun, an assistant professor of obstetrics and gynecology in the College of Medicine.
“It is growing so much in terms of research in quality. There are a lot of opportunities to contribute.”
With the committee refocused on bringing PDQs together, Holland said she hopes an onboarding process can be established for new PDQs to set expectations.
“I think the crux is it is a work in progress,” Byun said. “It’s continuous improvement to all be on the same page, to be aligned with the strategic plan, to be aligned with nursing and to be a liaison with the Housestaff Quality Committee.”