Side effects are often considered undesirable. But in the world of quality improvement, sometimes the unanticipated turns out to be wonderful. And wonderful is exactly the word surgical oncologist Martin McCarter, MD and Lindsay McGuiness, RN use to describe the relationships that improved because of their department’s quality improvement initiatives.
McGuiness nominated Dr. McCarter to be profiled because she believes he exhibits the UCHA standard of excellence of “quality” in all of his work. She says his focus on quality is most evident in the improved morale of her nursing staff in General Surgery and Transplant.
“Dr. McCarter has always been easy to talk to,” says McGuiness. “But he’s truly made a concerted effort to understand what our nurses do on a daily basis. He takes time to make sure he’s present for their questions and concerns.”
Before joining with McGuiness as a partner in the Certificate Training Program (CTP) of the Institute for Healthcare Quality, Safety, and Efficiency (IHQSE), Dr. McCarter embarked on developing a multidisciplinary esophageal clinic to address the complicated needs of this patient population, who can be treated by a dozen or more different providers for a single diagnosis of esophageal cancer. Dr. McCarter recognized widely varying practice patterns within the treatment program, so he developed a coordinated provider approach.
After the outpatient clinic programs implementation, Dr. McCarter was offered an opportunity to participate in the IHQSE. He asked McGuiness to be his IHQSE partner, hoping she’d help him further refine the esophageal cancer program success.
“When I asked Lindsay to be part of the team for improving the esophageal program, her answer was ‘what program?’ It was then that I realized the program involved only outpatient providers,” says Dr. McCarter.
The program was missing an inpatient care component.
“It suddenly became very clear to us that there were many issues in inpatient care that also needed to be addressed,” said McCarter.
With McGuiness onboard, the team began to examine processes within the general surgery unit. What they found was a great deal of variability in care. So they developed processes that would lead to a defined care pathway for each patient following surgery.
Which led to another unexpected outcome, and the thing that surprised Dr. McCarter most about the project.
“I’d been concerned about getting buy in from the surgeons and staff,” he said. “Change can be difficult, especially when the default perception is that it might require more work for your already busy staff.”
But Dr. McCarter learned that when you streamline processes and define expectations, everyone benefits. “When you involve everyone on the care team, you find better, more efficient ways to do things that benefit both the patient and staff,” said McCarter.
As expected, the quality of patient care and patient satisfaction have improved.
“I received two comments in the last week rating Dr. McCarter and his team as “excellent,” says McGuiness.
Patients are appreciating a better understanding of their care pathway.
“Lindsay mentioned that patients have told her that everybody who walks through their door seems to know what will happen next in terms of their care,” says Dr. McCarter.
The new processes have reduced length of stay in the ICU and inpatient unit by more than a day. And, McGuiness and her staff are seeing patients recovering more quickly.
“They’re out of bed and walking the hallways sooner, which is huge in terms of pulmonary health and overall strength,” says McGuiness.
Dr. McCarter and McGuiness have a strong appreciation for how important partnerships between medicine and nursing are to improving quality. Shared buy in, enthusiasm and focus are essential.
McGuiness says Dr. McCarter has served as a role model for physician/RN collaboration. While he’s happy to be seen that way, Dr. McCarter insists he’s a “quiet” role model.
“I’d like others to use our experience as a learning tool,” he says.
Thousands of people volunteer for clinical trials each year at the School of Medicine. Some offer payment; others give free health exams and follow-up.
View the CU Clinical Trials Website for volunteer opportunities.