SQUIRE Blog

The Great Balancing Act - An improvement blog by Sue Mooney

Susan Mooney

Beginning to Work on This  

My name is Sue Mooney and I work at a very small, 25 bed hospital in Lebanon, NH named Alice Peck Day Memorial Hospital.  Eighteen months ago I finished my National Quality Scholars Fellowship, burnt out on Obstetrics and ready to try something new.  APD was happy to have me come back to work in a new capacity - as the Medical Director for Quality Improvement.  I stopped practicing OB and carved out time for a Gynecology only practice.  I thought I was lucky - now I am not so sure.  Two months after I arrived, The Hospital Medical Director quit.  No one else was willing to take on the job, so his responsibilities landed on my lap.  Today, 18 months later, I have been offered the job of Chief Medical Officer of the hospital. I am flattered and humbled by the vote of confidence and not quite sure that I want the job. The last 18 months have been exceedingly challenging and often frustrating.  I spend too much time thinking about the economic survival of the hospital and why Doctors can't sign their medical records. I am overbooked with meetings and I spend too little time thinking about improving the quality of healthcare and even less time with front line quality improvement projects. And yet, I know that I am doing the right job for me and I also know that the QI work I am doing is valuable and should be shared with others. 

Where to from here?

Since Fellowship, I have worked for the SQUIRE project.  I am quite familiar with the guidelines - I helped to write and edit the E&E.  Now I get to see if I can use the guidelines to produce a paper that is worth publishing.  During my fellowship, I did an elective that evaluated guidelines for prenatal care.  Most prenatal care guidelines are organized by gestational age and very few of the guideline elements are "evidence based".  My advisor and I created a methodology for selecting guideline elements for improvement based on the context of the practice.  We then used my practice to test the theory.  What we found was a low rate of 1st trimester screening for asymptomatic bacteruria (this actually matters because aysmptomatic bacteruria is a cause of pyelonephritis in pregnancy which is a cause of preterm labor and birth.  Treatment has been shown to decrease morbidity and mortality).  For the past three years, I have been working to improve the screening rate.  Over the last six months, I have become convinced that we have improved.  I am pleased by this finding and also really concerned.  It's just a urinalysis and a culture - what's with the three years?  I want to understand why progress has been so slow and I want to know how to make the next project go more quickly. I also want to understand why only half the practice has gotten better.  I am hopeful that the SQUIRE guidelines will help me as I reflect on this project and begin the work of writing about it.