Muhammad Hasan Abid, MBBS; Master of Healthcare Quality and Safety program graduate
In today’s increasingly complex health care environment, clinicians and clinical administrators can benefit from receiving formal training on how to integrate patient safety and quality improvement initiatives into their organizations’ operations. Muhammad Hasan Abid, MBBS, recently attended Harvard Medical School’s Master of Healthcare Quality and Safety (MHQS) program and learned first-hand just how valuable this training can be in building a meaningful career in the health care space, both in the United States and also globally.
Putting QI Tools and Skills to Work
Abid, who is a physician trained in United Arab Emirates, with clinical experiences at diverse, top-tier health care organizations across the U.S., Middle East and South-East Asia, graduated from the Harvard program in the spring of 2019. Now, he works as a Quality and Patient Safety Physician Specialist in the Quality and Patient Safety Department at Houston Methodist Hospital - Texas Medical Center. In this operational role, he has a unique chance to put the tools and skills he learned to work supporting patient safety and quality goals. Abid is also an Institute for Healthcare Improvement (IHI) Fellow, bringing best practices in patient safety and quality improvement to bear on his ongoing commitment to improving quality of care around the world.
Abid refers to the Institute of Medicine's Crossing the Quality Chasm: A New Health System for the 21st Century report published in 2001 that set the stage for clinicians and clinician leaders to build up their knowledge in quality improvement tools, data analytics and leadership skills. This report sets out six domains of quality that all leaders must incorporate into their health care improvement efforts: safety, timeliness, efficient, effective, equity and patient centeredness. All of these elements, which also form the core of the Harvard master’s program, provide a foundation that leaders can build to create their own sustainable improvements to address areas of weakness in health care settings.
A Plan to Help Clinicians Improve Quality of Care
Abid points out that while in the master’s program, he had a chance to bring all of these aspects together himself through a project he worked on at Massachusetts General Hospital (MGH). This effort was done in conjunction with his Harvard program mentor, David Lucier, MD, MBA, MPH.
“We worked on improving provider and patient communication in the general medical inpatient units at MGH. We noticed that the busy time patients were being cared for by different providers was leading to confusion for patients, who don’t know who their ‘real’ provider was or who to talk to about any concerns,” Abid says. He adds that this was negatively impacting quality of care and increasing the opportunity for errors to occur.
To address the problem, he came up with a standardized card that contained basic information for each patient that would set the expectations as to who was caring for them and what type of tests or treatments they would receive.
“On each card, we left a place for the physician’s name to be added. Each physician received a batch that was personalized for him or her so when seeing a new patient, the cards could be handed out to let patients know who is in charge of their care,” he says, adding, “We saw fantastic results for this.” Through follow-up surveys, patients reported that the standardized cards helped them better connect with the doctors.
Helping Clinicians Overcome Human Factors to Create a Safe Culture
Abid says the steps that worked in this intervention can also translate in other settings to identify and address various types of quality care delivery issues, as well.
“It’s important to set an expectation for the staff to use essential patient safety behaviors based on common work-flow triggers, educate them on the error prevention tools and add constant reinforcement by embedding the patient safety champions within the frontline health care teams to provide just-in-time coaching,” he says. “This provides a great example of how health care organizations can incorporate an understanding of human factors to create a highly reliable and safe culture. When communication goes well, it increases patient satisfaction and reduces harm,” he says.
He recently also put these ideas into practice at Houston Methodist Hospital by implementing a patient safety coaching program. As a part of this program, inter-professional participants identified triggers in their daily work processes and applied safety tools themselves at the bedside, while also coaching their colleagues on how to use these tools.
“Interdepartmental collaborations and buy-in from key operational stakeholders were paramount in the success of this program. Like most innovative quality improvement and patient safety initiatives, it requires teamwork and the ability to form productive partnerships with colleagues across different swim lanes of your organization and patients,” he adds.
Using Informatics in Patient Safety
Abid says that another thing he learned through the Harvard program was that informatics, which can come from clinical databases, electronic health records and patient portals, also need to be a part of the quality improvement equation.
This requires linking data to what matters to the patient so you can build support on the front line. Data is also crucial to measure the impact of the intervention to see if it is effective. But Abid says there is one caveat: “When you have too much data, it’s easy to forget to look beyond it to focus on what matters to the patient.” Therefore, you need to find the right balance between what matters to the patient and where it impacts your health care organization’s strategic plan.
“We need to always remember that the patient is the most critical stakeholder, so we need to see things through the lens of the patient and understand what matters to them and what we need to improve,” he stresses.
Using Malpractice Data to Identify Health Care Safety Risks
Exploring risk assessment through medical malpractice data can also be beneficial.
“CRICO, the risk management foundation of Harvard, leads a course that’s part of the master’s program on how to incorporate malpractice cases into leading QI and patient safety efforts. This looks at how to involve people across all of the areas of the institution and connect them together to lead charge at the macro systems level,” Abid says.
Getting Strategic With Health Care QI Efforts
At the heart of most successful quality improvement efforts is the ability to think beyond the current practice paradigm to utilize the perspective of system redesign and to leverage advanced technological platforms. This allows leaders to implement the best patient centered practices that are linked to meaningful operational and clinically relevant measures.
“As the result of what I learned at Harvard, I developed my vision in quality improvement and learned that it is a lot about driving change in culture. I’ve also become more strategic in how to implement quality improvement efforts and I’ve learned how to partner with others across the world,” he says.
For instance, at the global level, Abid launched a call for action for the major health care stakeholders from across Pakistan (where patient safety is still in an infancy phase) to collaboratively work on patient safety by promoting the culture of speaking up for patient safety during the inaugural world patient safety day by the World Health Organization.
“This master’s program was a transformational experience for me. It helped me define my goals as an activated physician, and I have emerged as a quality and safety leader in my new roles,” he says.
Abid, Muhammad Hasan MBBS, MHQS, Quality and Patient Safety Physician Specialist, Quality and Patient Safety Department, Houston Methodist Hospital - Texas Medical Center; Institute for Healthcare Improvement Fellow. Phone interview, Jan. 30, 2020.