My Improvement Project Journey
How Physicians Can Participate in Improvement Work
By Kaniksha Desai, MD
Kaniksha Desai, MD, is Clinical Associate Professor of Endocrinology, Gerontology & Metabolism in Stanford's Department of Medicine.
My journey in quality improvement began during my residency, when I first became aware of the impact that broader healthcare systems invariably play in individual patient outcomes. When I completed my fellowship and began work as an attending, my understanding of these issues naturally grew as I came to know that learning does not end when you finish training and that medical teams are often limited by the social, financial, and cultural frameworks that they function within.
I learned after leaving the relatively sheltered world of residency and fellowship the important distinction between medicine and healthcare, and that the latter is as much socioeconomic as it is biomedical.
The COVID-19 pandemic has exacerbated many problems in healthcare including inefficient and inequitable care, physician and provider burnout, and inadequate staffing. These issues are interrelated in complex ways and it has become increasingly challenging for individual physicians to see beyond their own practices.
For female physicians, domestic responsibilities often ensure even less time is left to consider and work on improving the systems that underlie our individual patient interactions, often leading to more burnout.
In order to solve these complex problems, it has never been more important for practicing physicians to be at the administrative forefront of healthcare systems.
Stanford Medicine supports the participation of clinical faculty in solving these problems at the institutional level through the Improvement Capability Development Program (ICDP). ICDP specifically aims to support the development and execution of improvement projects, funding participating physicians’ time and project management costs and offering courses such as RITE (Realizing Improvement Through Empowerment) and CELT (Clinical Effectiveness Leadership Training).
As junior faculty, I had the opportunity to participate in a CELT course. CELT provided me with the support needed to improve the availability of appropriate pre-clinic visit imaging for thyroid cancer patients. Not only did my project positively impact my patient care from the patient perspective, my feeling is that these improvements likely benefited me and my colleagues’ “physician experience” by improving the efficiency of our practice and allowing us to focus more on the patient. Additionally, the project provided me with a skillset that I frequently use in my other leadership positions and that has helped me develop my professional network. Currently, I am the physician director for RITE where I support others in their improvement journeys.
My experiences with improvement work have taught me how it is possible - and vital from a sustainability viewpoint - to align outcomes for the patient and physician. As practicing physicians, we have a unique and central perspective as to how this can be achieved and, subsequently, a responsibility to guide broader system-level changes with this in mind.
I have found participating in improvement work has not only helped the care I provide to patients but also given me greater professional fulfillment and overall work satisfaction. I invite everyone reading to do the same!
