Dan Kelly | Master of Science in Healthcare Quality and Safety
Daniel Kelly, MD, is a pediatric intensivist at Boston Children’s Hospital. Throughout his residency and fellowship training, Kelly had minimal training in quality improvement and patient safety. While working with his team at the hospital, he realized the need for someone to focus on these areas and started taking on more of a quality and informatics role. “This wasn’t something that was on my radar and it was not part of my career plan, but what started as a very small effort grew into a divisional portfolio and I really enjoyed the work.”
Kelly found the quality improvement and patient safety work to be highly collaborative as he engaged with multiple stakeholders in the critical care unit. Previously, he had viewed issues through a clinical research lens, but this collaboration allowed the team to address issues in real time. As he started to grow and take on more quality and safety initiatives at the hospital level, Kelly wanted to build out his own skillset with formal training.
Through his local mentors and connections, Kelly had taken a few training courses, but felt that he was lacking knowledge in fundamentals of improvement statistical methodology. He then learned about the Master of Science in Healthcare Quality and Safety program at Harvard Medical School. After attending an information session, Kelly quickly realized it was exactly the program he was looking for. With young children at home and a busy clinical schedule, he was hesitant to enroll, but the flexible schedule and virtual format made it possible. “I recognized it was a short-term investment for long-term gain.”
One of the topics that the program faculty talks a lot about is developing the right mindset—from getting accustomed to being a student again to understanding concepts and ultimately applying the theories in practice. The capstone project is the key component in building the right mindset and practicing these applications. “You truly do start to see problems in a different light,” Kelly says. “You start to recognize that there are not just individual contributors, but also systematic approaches to addressing those problems along with other quality and safety threats.”
For his capstone project on pediatric critical care patients, Kelly saw the need to improve care and safety for patients with chronic respiratory failure requiring tracheostomy and ventilator support and to simplify the complex discharge process for families. He focused on the initial discharge to home, how to improve care coordination, and parent or caregiver education and safety. Many families were choosing to get the training needed and go home versus transitioning to a facility, so his goal was to make the process more efficient and ease the family’s concerns upon discharge.
Through the initial process evaluation, Kelly recognized there were parallel processes happening, but little communication across channels. To address this problem, the team started having multiple stakeholder meetings using swim lanes and fishbone diagrams and came up with an initial set of interventions through improvement cycles. By the end of the evaluation, Kelly and his team had standardized exactly what the process would look like, including a checklist of criteria that needed to be met before moving on to the next step of training.
Certain tasks were assigned to specific groups, such as nurses, respiratory therapists, and case managers, and all the information was managed in an online task management system. Through this system, anyone on the care team could log in to see where the patient was in the pathway, what competencies had been completed or remained, and what tasks were assigned to their team. All the associated documentation was also uploaded into the system, so when the practitioner was meeting with the patient, they could access everything in one place. With this new streamlined process in place, Kelly and his team have eliminated up to two weeks of ICU time for the patients, improved patient satisfaction, and decreased readmission rates.
The team is disseminating this new process, so it not only can be shared with other hospitals, but also can help establish a resilient and safe process that remains consistent when there are team changes, such as staff turnover. Kelly hopes that the framework he initiated within Boston Children’s Hospital will serve as a model for other hospitals to adapt within their own systems.
While initially unsure about committing to a master’s degree program due to his busy work schedule and family life, with the help of a supportive spouse and many conversations with his divisional leaders at work to restructure his schedule, the whole process became much easier to facilitate. If Kelly knew that he had a busy clinical schedule coming up, he was able to get ahead of his program work.
Kelly acknowledges how applying the theory in the classroom to his clinical work has accelerated his professional growth. He quickly became a divisional expert, was assigned to lead more hospital-level meetings, and serves on a national steering committee for quality improvement. “If I didn’t have the master’s training, and hadn’t focused my time and energy to develop the right skill set, I’m not sure the promotions and new opportunities ever would have happened.”