Dr. Rebecca Perkins is an Associate Professor of Obstetrics and Gynecology at Boston University School of Medicine, and a practicing gynecologist at Boston Medical Center. Her career is dedicated to reducing health disparities in cervical cancer. Her current research focuses on improving utilization of HPV vaccination and cervical cancer screening guidelines. Dr. Perkins is currently working on national projects related to HPV vaccination and cervical cancer prevention with the American Cancer Society, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the American Society for Colposocpy and Cervical Pathology.
Questions & Answers
Our program consists of 6-8 educational sessions that are one hour long. We understand the value and rarity of time designated for clinical team meetings, in addition to competing priorities, in the average clinic. If your clinic has team meetings only once per month, it may be difficult to designate that much of your calendar to one project. Certain sessions may be shortened, including the introduction and data feedback (session 1), and the PDSA cycles (sessions 5-7) if that is necessary to accommodate competing agenda items. In addition, session 2 (HPV basics) may be done on an individual basis outside of work time if you are using the web-based format, though this is not ideal as engagement is typically higher in the group setting. Choosing the action plan (session 4) should be given the whole hour to ensure that the whole staff has time to discuss and decide on a mutually desirable plan. For sessions 5-7, while it is ideal if your team can spend the whole hour discussing their experience with your chosen action plan and observing the impact of the action plan through the data, if this is not possible, a brief encounter with a review of performance data can still enforce the significance of the initiative, help drive the intervention and allow providers a chance to contribute any significant feedback based on their experience with the intervention.
Our intended audience is already broad in that it includes any medical professional who treats patients in the appropriate age ranges for vaccination. Anyone involved in facilitating vaccination in a healthcare setting would benefit from participating in this program. The program is not designed for populations or facilities that do not provide vaccination.
Representation and engagement from each profession on the clinical team facilitates success. Seeking feedback from nurses, medical assistants, data analysts and any other professions relevant to your HPV vaccination workflow can ensure that the action plan chosen is realistic and has advanced buy in from all members of the team. An individual who implements an intervention that he or she helped create will have more stake in its success.
An enthusiastic project champion can facilitate your team’s motivation and satisfaction while participating in the project. It is essential for the champion to celebrate successes, learn and adapt from ‘failures’ (although in PI/QI there is no such thing, only learning!) and facilitating open discussions where all opinions are valued. The champion might consider screening survivor videos available on the American Cancer Society website (https://www.youtube.com/playlist?list=PLpB8X9MugZYaPx-OieXYhfXEEpSzCkYwB), or perhaps reaching out to their OBGYN colleagues to relate real stories of patients dealing with the effects of HPV from their home clinic. This can engage the team on a deep emotional level and motivate them at the project launch.
A team will benefit if one of the members knows how to facilitate changes to the EMR system. EMR requests can often face long queues but are incredibly helpful for sustainable interventions. It can be difficult to navigate EMR integration without the appropriate support.
Challenges can include:
- Long queues delaying data reports from an analyst is a challenge, especially if your group is not willing to audit charts throughout the project.
- Providers who are not used to looking at data and participating in QI might be defensive when presented with their own performance data. It is important that the clinical champion takes steps to build confidence in the data before it is first displayed to the group. Be transparent about the exact definitions of your measures, where the data came from and be prepared to address concerns. Try not to let your group discussion get hung up on picking apart the perfection of a report (it isn’t perfect and it never will be!) and instead focus on the learning and growth that is possible through this experience. A champion that creates a supportive climate without imposing judgement on the team can help providers get past this discomfort.
- Teams that do not have any protected time for group meetings could find it extremely difficult to engage a broad team to run this program.
Session evaluation forms are included in the implementation guide. In addition, the following questions can be considered if there is the capacity to collect and analyze more qualitative data.
- Individual Commitment to Change
At the end of the project, a leader might survey all participating individuals and ask them to identify all the ways they have changed their individual practice. Perhaps the group intervention focused on an outreach program to bring patients into the clinic for vaccine. The data will show you if the group intervention was successful, but you may not learn all the ways individual providers made changes to the way they presented the vaccine to their patients or if every single provider actually adopted the team’s intervention. This question might look like: “At the conclusion of this initiative, I have made the following changes to my practice…”.
- Engagement
It would be interesting to learn if providers who attended more meetings had a better success rate in adopting the team’s intervention and increasing vaccination.
- Satisfaction
This model aims to have an entire team collaborate in an educational program designed to facilitate performance improvement. Many participants may have no experience with quality improvement. It would be interesting to observe the ripple effects of this initiative and find out if members of the team are motivated to participate in further improvement efforts based on a positive experience with this model.