Dr. Gregory A. Maynard has spent most of his career working to improve patient care, not through new treatments, but by designing better care processes.
As a pioneer in developing protocols for venous thromboembolism prevention and glycemic control, Dr. Maynard has ushered in significant patient safety improvements at the University of California at San Diego. And he has been just as active in helping to roll out these protocols and techniques beyond his institution to hospitals around the country.
“The same principles basically get used over and over and over again,” he said. “While there's some nuances between the different projects, you're really using the same principles that should be adopted and adoptable at other places.”
Dr. Maynard, who is the chief of the division of hospital medicine at UC San Diego, is also the coleader of a national collaborative on VTE prevention and leads a national task force of the Society of Hospital Medicine to promote effective glycemic control in hospitalized patients.
His team has also tackled discharge processes and transitions of care, delirium detection and management, pneumonia management, infection prevention, and osteoporosis management.
When selecting areas to work on, Dr. Maynard and his team have several criteria. One of the key elements is choosing an area where there's a large gap between the best practices and the actual practices. “You have a chance to make a fairly large difference based on that gap,” he said.
They also try to look ahead and anticipate what areas will be targeted by groups like the Joint Commission or the National Quality Forum.
Once they select a clinical area, they often have to overcome a lack of awareness in the hospital staff. For example, a hospital may already have a protocol for delirium, but the physicians and nurses don't know about it. In that case, the key is to find ways to trigger the protocol, Dr. Maynard said.
Triggering the protocol has to involve some recognition of the condition either through an electronic health record or through a specific screen for the condition. “Something has to make it happen automatically so that it comes to the forefront,” Dr. Maynard said. “You can have the best protocol in the world to treat something, but if someone doesn't say, 'Hey, this is a good candidate for the protocol,' then it might never get used.”
One way to bridge that gap is to build a routine screening process into admission order sets or a nursing process, Dr. Maynard said. The prompt can also be as simple as a check box on the patient's history and physical form.
Dr. Maynard has some advice for hospitalists looking to start their own projects: “Quality improvement is not for sissies.” Implementing a successful quality improvement program is hard work, he said, and requires a team of persistent, driven individuals. It also helps to build a strong relationship with the hospital's informatics team and the people doing the data collection, he said.
Hospitalists should consider getting training in quality improvement, Dr. Maynard said. He recommended starting with the online offerings of organizations like the Society of Hospital Medicine and the Institute for Healthcare Improvement.
He advised hospitalists to think early on about how to make their projects generalizable, to think about whether improvements would be portable to other settings, and to use reliable metrics.
“I think people are hungry for this information about how to do quality improvement well,” Dr. Maynard said.
'I think people are hungry for this information about how to do quality improvement well.'
Source DR. MAYNARD