In starting a QI program, Eastwood Clinic’s Executive Director pulled leadership from his clinical, financial and administrative teams to identify potential problems through a brainstorming session. They developed a list of problems they would like to address through QI and looking at relationships between these problems using an affinity diagram. They decided that they wanted to address problems they were having with their diabetic patients. One problem in particular, was that they found that nobody understood how often patients diagnosed with diabetes received foot exams and they wanted to know how to address this. They use a fishbone chart to think through root causes and how to address them. They developed a flow chart to document how a patient moves through the clinic and spoke with clinicians about the optimal time to conduct foot exams. They decided to ask clinicians to conduct foot exams when they first sat down to discuss a diabetic patient’s status and decided to put up a sign at eye level for physicians when they first sit down that reminds them to ask the patient to take off their shoes. They also included a special field in their electronic medical record which gives clinician a place to document whether they conducted a foot exam. Once both the signs and the new field were in place, they communicated with providers and made sure they understood their effort to document foot exams and used a histogram to look at how the number of documented diabetic foot exams changed from month to month following the start of the intervention.
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