More about the Balancing Act
The hardest part is finding the time to sit and look at the data and think. As I try to balance my clinical, administrative and academic responsibilities (not to mention my personal life), I sometimes feel as though I am shoveling waves at the beach. Take today for example. I got out of the OR at 10:30 with the best of intentions to come back to my office and work on this paper. Now it is past noon, the phone has not rung in 5 minutes and no one is standing in my doorway wanting to talk. So, here I sit, an hour and a half behind schedule, trying to write something worth reading.
It is a challenge to balance my time. It is an even greater challenge to balance the worlds that I inhabit. Having graduated from the VA National Quality Scholars Fellowship and having obtained a Master's Degree from Dartmouth, and working for the SQUIRE project, I appreciate the necesity of bringing some academic rigor to my improvement work. But I work at a very small, rural, community hospital. Many folks here are bright and talented and dedicated to their jobs. And they are far removed from the academic world. Few have any formal training in Quality Improvement. Many have never taken a statistics class. Everyday I struggle with this. When I do an improvement project, do I need to use statistical process control? Or can I be less rigorous? How do I talk about sample size and ANOM analysis without alienating everyone in the room? How do I celebrate someone's success even when I know that the "improvement" they are talking about is really only common cause variation? Balancing between an academic and a non-academic world keeps me intellectually engaged and grounded in the real world. I don't want to be anywhere else. But sometimes I do feel as though I am perched on a very narrow balancing beam.
It seems simple - all pregnant women should have a urine culture performed during the first trimester as part of routine prenatal care. The thing that interests me the most about improvement work is that the things that seem so simple are so hard to pull off. The local problem (as the guidelines like to call it) that I have been working on is this: Two years ago, while working on my Master's degree, I discovered that not all women who get their prenatal care at APD, get first trimester urine cultures. Interestingly, they do reliably get other recommended care (like a blood type and Rh test). I actually had several goals for this project and, not surprisingly, they have evolved over time. Initially, I set out to pilot test a data gathering methodology that was part of a larger QI project. Once I discovered the aforementioned gap, I set out to try to close it which necesitated that I understand why it existed in the first place. Now I am trying to understand why half the practice got better while the other half did not...And I am trying to figure out what to do about the half that has shown no improvment. Lots to think about, and write about, if I can find the time.