QI and the risk of initiative fatigue

January 12th, 2015

I have to admit that I’m a sucker for a cool quality improvement project. I love reading about them, and I’m always interested in running case studies on innovative initiatives in Hospital Peer Review or Hospital Case Management – especially when there’s good outcomes data to demonstrate their success.

I doubt I’m the only one who gets caught up sometimes in the “gee whiz” aspect of project design, or in the quality improvement principles, techniques and theories that inform it.

But in the real world, even the best-laid plan gets you nowhere if you don’t have the resources – especially the human resources – to pull it off.

That’s why I was so intrigued by a recent blog post at Health Affairs called “The Dangers of Quality Improvement Overload.”

Actually, I was hooked just by the title. I’d never heard the phrase “quality improvement overload” before, but it made immediate sense. Everyone, regardless of occupation, has likely had the experience of dealing with extra and unexpected work. Maybe if you were given a good reason for the extra work, or were included somehow in the development of the idea behind it, it wouldn’t seem so bad. You might even have some enthusiasm for the new assignment.

But, as the authors of the Health Affairs post makes clear, that isn’t always the case for health care workers charged with implementing a slew of quality improvement and safety initiatives. The authors write, “Requiring health care providers to improve on all mandated measures at once, in an atmosphere of reduced reimbursements and frequent staff shortages, is a goal that risks burnout, discouragement, and apathy – all signs of initiative fatigue.”

The consequence of all that can be staff who just go through the motions in terms of what they’re expected to do.

The authors recommend focusing on achieving “small wins” first. They write, “This approach allows for the creation of steady momentum by first convincing workers they can improve, and then picking some easily obtainable objectives to provide evidence of improvement.”

Sounds reasonable. But I think the most important take-away is simply to remember that no matter how impressive it looks on paper, your next great QI project won’t succeed without a crew of people committed to helping it succeed.