Quality Improvement Commons^™

Reducing Acute Healthcare Services With Self-Management Of Blood Pressure Monitoring Through Remote Patient Monitoring For Hypertensive Patients A Quality Improvement Project, Becky J. Wagner

Doctor of Nursing Practice (DNP) Manuscripts

Hypertension (HTN) affects nearly half of U.S. adults and remains a leading cause of preventable emergency department (ED) visits, hospitalizations, and healthcare costs due to poor blood pressure (BP) control (Fryar et al., 2024; Mullins et al., 2019). Traditional care models often lack the continuous monitoring and timely intervention needed for effective chronic disease management. Remote Patient Monitoring (RPM) provides an innovative approach by delivering real-time BP data, enabling early clinical intervention, and encouraging patient engagement in self-management (Omboni et al., 2020).

This Doctor of Nursing Practice (DNP) project evaluated the effectiveness of an RPM intervention in reducing acute healthcare …

Advanced Practice Provider-Physician Collaboration And Medical Staff Governance: A Framework For Patient Safety, Nicolas Testa, Kaysha Hervey, Cynthia Borum

HCA Healthcare Journal of Medicine

The growth of advanced practice providers (APPs) is occurring in parallel with persistent and projected physician shortages. One important solution and increasingly visible response to these workforce challenges is the expanding role of APPs. Strong physician-APP partnerships can help distribute workload, improve access, and support sustainable practice with the delivery of safe, quality patient care. The future of clinical care will depend on effective APP-physician collaboration grounded in sound credentialing, clearly defined supervision and practice expectations, and robust medical staff monitoring programs. We describe the governance and oversight processes in a large health care system to assess and support APP …

A Conceptual Framework For Clinical Quality Oversight In Telehealth-Enabled Home-Based Urgent Care, Taylor Spencer, Jason P. Williams

HCA Healthcare Journal of Medicine

Background

Home-based urgent care serving frail older adults should aspire to high-quality clinical care with optimal patient outcomes. However, monitoring and ensuring this quality can be challenging. For example, telemedicine and value-based frameworks introduce substantial complexity to clinical quality monitoring.

Purpose

We describe the conceptual framework for a multidimensional quality monitoring program within a national home-based urgent care model.

Framework Description

Medical care was delivered via a multi-state home-based primary, palliative, and urgent care practice serving medically complex Medicare Advantage (MA) populations. Our model of care incorporated distributed clinical and operational teams delivering 24/7 care via telephonic triage, video-enabled encounters, …

A Heuristic Tool To Enable Root Cause Analysis Of Safety Events, William D. Porter, Kianca Joseph, Demitria Stafford, Kurt Larson, John Mier, Michelle Butler-Jackson, Musaddiq Waheed

HCA Healthcare Journal of Medicine

Background

Hospitals routinely collect wide-ranging data related to quality, efficiency, and clinical practice. As part of these efforts, patient safety event data are collected, compiled, and analyzed to drive process improvement.

Methods

We present a novel adaptation and application of the Department of Defense Human Factors Analysis and Classification System (HFACS) as a heuristic tool to improve the conduct of root cause analysis (RCA) sessions that follow serious patient safety events. To assess individual knowledge improvement after reviewing the heuristic tool, a 1-page summary (including a graphical image of the tool) was developed and provided to a convenience sample of …

Critical Care Catalyst: The Impact Of Trauma Nurse Leads On Mortality, Patient Outcomes, And Throughput, Danielle Brady, Jessica L. Brady, Hannah Dice, Parker Hu

HCA Healthcare Journal of Medicine

Background

Trauma is the leading cause of years of life lost in the United States. Dedicated trauma nurse leaders (TNLs) coordinate resuscitation and streamline care, but data evaluating their clinical impact at level I trauma centers are limited. We evaluated the association between a newly implemented dedicated TNL program and patient outcomes.

Methods

This single-center, preimplementation and postimplementation observational study at an urban level I trauma center compared adult tier 1 and tier 2 trauma activations from the pre-TNL period (January 1, 2017, through April 30, 2020) with the post-TNL period (May 1, 2020, through December 31, 2023; 8 dedicated …

A Digital Safety Detection And Control System For Proactive Risk Management, Karla Miller, Jennifer Lee Mcalister, Keri Melson, Gita Nadimpalli, Becca Moore, Brett Powell, Kenneth E. Sands, Mary Catherine Harris, Cali Cerami, Shanna Arnold Egloff, Yauheni Solad, Randy Fagin

HCA Healthcare Journal of Medicine

Patient safety remains a defining dimension of health care quality, yet systems rely on retrospective assessment after harm has occurred, limiting visibility into upstream risks, including process failures and near misses. This challenge underscores the need for an approach that unifies fragmented safety activities to support proactive safety risk management. We describe a phased pilot implementation and evaluation framework of a Digital Safety Detection and Control System (DSDC) within a large integrated health care system to operationalize enterprise-wide patient safety. The DSDC integrates governance, human oversight, and digital capabilities across 4 operational phases: detection, triage, investigation, and learning. These capabilities …

Pharmacovigilance As An Act Of Awareness And Mindfulness, Mahima Silas, Hale Z. Toklu

HCA Healthcare Journal of Medicine

The term “pharmacovigilance” defines the activities related to the collection, detection, assessment, monitoring, and prevention of adverse reactions due to pharmaceuticals. While it is often framed as a technical and regulatory discipline, it can also be understood through a more reflective lens as a form of mindfulness practice. At its core, pharmacovigilance requires a way of thinking that closely mirrors mindfulness, including sustained attention, openness to uncertainty, and deep awareness of human experience. Viewing pharmacovigilance in this way reframes it not just as a safety mechanism, but as a thoughtful, patient-centered approach to medicine.

Sedation Minimization And Early Mobility To Prevent Intensive Care Unit Delirium, Alana M. Kugelard

Lynchburg Journal of Medical Science

The purpose of this paper is to synthesize current evidence on sedation minimization, early mobility, and multicomponent care bundles for the prevention of intensive care unit (ICU) delirium in critically ill adults. ICU delirium is a common and serious complication associated with increased mortality, prolonged mechanical ventilation, extended ICU and hospital length of stay, and long-term cognitive impairment, making it a significant safety and quality-of-care concern. A literature review was conducted using PubMed and the Cochrane Library, with search terms including “ICU delirium,” “sedation minimization,” “light sedation,” “early mobilization,” and “ABCDEF bundle.” Filters included adult populations, peer-reviewed studies, randomized controlled …

Persepsi Dokter Terhadap Kompetensi Perawat Di Rsud Siti Aisyah Lubuklinggau: Analisis Domain Komunikasi, Profesionalisme, Dan Kolaborasi Tim, Novita Purnamasari, Wiku Bakti Bawono Adisasmito

Jurnal ARSI : Administrasi Rumah Sakit Indonesia

This study analyzes doctors' perceptions of nurses' competencies at Siti Aisyah Regional Hospital in Lubuklinggau across three domains: communication, professionalism, and team collaboration. Doctors' perceptions are important for supporting interprofessional collaboration, quality of patient care, and patient outcomes. The study results are expected to identify competency gaps and provide an evidence-based foundation for developing measurable and effective nurse training programs. The study used a quantitative descriptive design with a cross-sectional approach, with a sample of 24 doctors who evaluated nurses' overall competencies in their work units. Data were collected through a structured questionnaire containing 11 Likert-scale items and were analyzed …

Practical Implementation Of An Osteoarthritis Treatment Program In A Radiation Oncology Center Within Md Anderson’S Cancer Network, Aaron Shaykevich, Adam Grippin, Warren Floyd, Brady Cripe, Alexander Augustyn, Shalin Shah, Samantha Buszek

Advances in Cancer Education and Quality Improvement

Background: Low-dose radiation therapy (LDRT) for symptomatic osteoarthritis (OA) can add to the workload of radiation oncology services, particularly in small centers with limited capacity and staff. After we launched an OA LDRT program in December 2024, referrals grew rapidly at our rural, single-linac radiation oncology practice at UT MD Anderson’s Cancer Network Partner site (Community Health Network in Indianapolis, IN), leading to long wait times and workflow strain.

Methods: We used load leveling to reserve capacity for cancer care and make OA scheduling predictable. Five 15-minute benign consult slots were set aside each week. Patients then went on a …

From Burnout To Belonging: A Faculty Well-Being Director's Perspective On Leadership, Workplace Culture, Organizational Efficiency, And The Broader Role Of Physician Well-Being, Ajit K. Bisen

Advances in Cancer Education and Quality Improvement

Burnout remains a major challenge in health care, despite increasing investments in physician well-being initiatives. As the faculty well-being director for my department, my perspective on physician well-being has shifted from focusing primarily on individual resilience, mindfulness, and wellness initiatives to recognizing the important roles of leadership, workplace culture, and organizational efficiency. Physician well-being is an essential foundation for high-quality patient care, stronger teams, patient safety, quality improvement, and healthier organizations. Here, I discuss the 3 key shifts in thinking that have influenced my approach as faculty well-being director.

Towards Upstate Well Center: Lessons Learned In Organizational Well-Being Over The Last Decade, Nayla M. Khoury, Asalim Thabet, Kerryanna M. Elhage, Jarrod L. Bagatell, Kaushal Nanavati, Leslie J. Kohman

Advances in Cancer Education and Quality Improvement

Background: Upstate Well has evolved over more than 10 years through the integration of multiple partners, programs, and initiatives. The scope and complexity have increased alongside stronger relationships, shared ownership, and supportive infrastructure.

Methods: This report analyzes implementation lessons learned through program development and impact assessment over 5 years.

Results: Upstate has a growing number of wellness champions across the institution, collaboration among multiple wellness programs, and lessons learned from select programs. Themes include (1) supportive infrastructure, including new full-time equivalent positions to support Upstate Well; (2) active collaboration between stakeholders, and appointed wellness champions in each department; (3) improved …

From Career Alignment To Action: Strengthening Academic Mentoring Through Structured Reflection, Fanni Farago, Julie Izzo, Courtney L. Holladay, Diane C. Bodurka, Michelle Hildebrandt, Suezen Salinas

Advances in Cancer Education and Quality Improvement

Background: As faculty roles and responsibilities become increasingly complex and demanding in contemporary academic medicine, fostering and sustaining faculty well-being has emerged as a critical organizational priority. In response to this need, this brief report describes early insights from the first year of implementation of the Academic Mentoring Program (AMP), a formal and expanding faculty mentoring initiative at UT MD Anderson. Our findings highlight the potential value of incorporating a structured career development assessment (CDA) tool into the mentee intake and engagement effort, evaluating development alignment, professional activities, and organizational expectations.

Methods: We conducted descriptive statistical analysis and qualitative thematic …

Feasibility And Pilot Study Of Implementing Mindfulness-Based Attention Training In A Pediatric Health Care Setting, Thomas B. Ayres, Seth Sonnevile, Angela Myers

Advances in Cancer Education and Quality Improvement

We present herein our preliminary evidence from a pilot study of the feasibility of implementing Mindfulness-Based Attention Training (MBAT) in a pediatric health care institution. MBAT has been implemented primarily in military settings, representing another high-stress work environment. Furthermore, MBAT has had favorable evaluations from being implemented with medical students. Mindfulness-based interventions have received increasing attention in health care environments. This interest from health care institutions and the focus on developing attention-based resources through MBAT created a use case for implementing MBAT. We had 5 health care workers with a variety of job roles in our institution complete a train-the-trainer …

Pebbles In The Shoe: A Multidisciplinary Program To Identify And Resolve Workplace Inefficiencies In A Pediatric Oncology Division, Reeja Raj, Kate Gazouleas, Pavilia Francis, Nancy Gordon, Vidya Gopalakrishnan, Amy Heaton, Ishwaria Subbiah, Priti Tewari, Harjeet Singh, Aaron Walton, Shehla Razvi, Martha Askins, Lisa Triche, Karen Moody

Advances in Cancer Education and Quality Improvement

Introduction: Occupational burnout is a significant concern among pediatric oncology faculty and multidisciplinary staff, characterized by emotional depletion, detachment from work, or a diminished sense of professional achievement. Inefficient work processes can be important contributors to burnout. This report describes the implementation and outcomes of Pebbles in the Shoe (also referred to as Pebbles), a pediatric division–wide initiative designed to address workplace concerns and inefficiencies.

Methods: The Pebbles program was developed and led by our pediatric division's wellness task force. Division members were invited to anonymously submit work-related concerns and irritations through a QR code–accessible electronic form. Five discipline-based work …

Aligning Trainee Leave Policies Across Surgical Fellowships: Development Of A Division-Wide Framework For Leave And Program Completion, Helen M. Johnson, Mara B. Antonoff, Kelly K. Bree, Maxwell G. Lewis, Heather A. Lillemoe, Margaret S. Roubaud

Advances in Cancer Education and Quality Improvement

Background: Surgical fellows and program leaders face difficulties navigating parental, caregiver, medical, and personal leave due to variation in policies. A Division of Surgery (DoS) Trainee Leave and Parental Support Task Force was convened at The University of Texas MD Anderson Cancer Center to review existing requirements and develop a harmonized framework for trainee leave and fellowship program completion.

Methods: The Task Force conducted a comprehensive review of policies relevant to surgical fellow leave and graduation requirements, identified best practices, and drafted a DoS policy. The policy was refined iteratively through engagement with key stakeholders, including program directors, department chairs, …

Creating A Culture Of Well-Being By Removing Barriers To Participation In A Multi-Campus Cancer Center, Adam Siegman, Miranda M. Phillips, Jennifer Bickel

Advances in Cancer Education and Quality Improvement

Background: Healthcare professionals in geographically distributed cancer care settings may face barriers to accessing workforce well-being resources due to geographic distance, staffing constraints, and operational demands. Disconnect & Refresh was developed to improve access to restorative wellness opportunities across community-based cancer care sites.

Methods: Disconnect & Refresh was implemented at The University of Texas MD Anderson Cancer Center across 4 Houston area locations. The initiative included BeWell Paws, virtual reality meditation, chair yoga, and creative wellness activities delivered during the workday. Participation was voluntary and tracked through employee badge scans. Participants were invited to complete an anonymous post-event survey, and …

Faculty Growth Through Academic Career Development Committees, China Crowder, Rebekah Filson, Elizabeth Grubbs, Carin Hagberg, Anne Tsao

Advances in Cancer Education and Quality Improvement

Academic medical centers face ongoing challenges in providing structured, career -stage-–specific faculty development, mentorship, and leadership opportunities that effectively engage faculty throughout their academic careers. The Academic Career Development Committees at The University of Texas MD Anderson Cancer Center represent a structured, faculty-driven model designed to promote professional growth, mentorship, and leadership engagement across all career stages. Grounded in established principles of faculty development and mentorship in academic medicine, the Academic Career Development Committees foster cross-level collaboration, inclusive participation, and intentional skill-building. Outcomes were measured through participant evaluations, attendance and participation trends, mentorship engagement indicators, and qualitative feedback gathered from …

Leadforward: A Department-Based Leadership Development Program To Support Workforce Well-Being, Leisa A. Bryant, Denise Marshall, Loreal Williams, Miranda M. Phillips

Advances in Cancer Education and Quality Improvement

Introduction: Leadership development is increasingly recognized as an important strategy for supporting workforce engagement, professional growth, and succession planning in healthcare settings. To address leadership development needs within Food, Nutrition, and Patient Transportation (FNPT) departments, a structured leadership development program, LeadForward, was developed for emerging and midlevel leaders.

Project Description: LeadForward was implemented within the FNPT departments at a comprehensive cancer center. Ten participants completed the inaugural cohort. The curriculum was organized into 6 instructional modules designed to develop leadership competencies among emerging and midlevel leaders. Leadership outcomes were assessed using pre- and postprogram self-assessments across 14 leadership competency …

Standardized Preprocedure Protocolling Of Stereotactic Breast Biopsies Enables Device-Level Supply Chain Forecasting: A Multisite Quality Improvement Analysis, Megan Kalambo, Mike Everding, Maria Montemayor, Falguni Patel, Mohit Nath

Advances in Cancer Education and Quality Improvement

Background: Breast imaging depends on single-use, vendor-proprietary consumables produced by a concentrated set of manufacturers. During supply shortages in 2026, healthcare organizations faced urgent pressure to shift from reactive to proactive inventory management. Stereotactic breast biopsy needle shortages revealed that traditional forecasting based on procedure volume lacks the granularity needed for device-specific demand. We aimed to enable device-level forecasting through standardized preprocedure protocolling.

Methods: In a retrospective analysis of 1,456 stereotactic biopsies across 4 breast imaging sites (June 2025 to June 2026), compliance with a standardized electronic protocolling tool that captured lesion count and needle size (standard vs. petite) was …

Critical Daily Dose Warning Optimization In An Electronic Health Record At A Tertiary Cancer Center, Mckenzie Erwin, Sadika Eslaminejad, David Perez, Jesni Mathew

Advances in Cancer Education and Quality Improvement

Objectives: Clinical decision support is a form of health information technology utilized by electronic health records (EHRs) to reduce prescribing errors. The challenge of incorporating clinical decision support into medication workflows is balancing alert fatigue with clinical appropriateness. At our 777-bed tertiary cancer center, one form of interruptive clinical decision support is critical dose warnings that appear when the ordered dose deviates by a defined threshold from the maximum dose. Our tertiary cancer center relies on a third-party data vendor to provide maximum dose limits that are integrated into the EHR medication ordering process. At the time of project initiation, …

Implementation Of A Low-Cost Tobacco-Free Intervention In A Permanent Supportive Housing Program To Address Cancer Disparities Among People Who Have Experienced Homelessness, Ammar D. Siddiqi, Phoebe Wong, Cathy Crouch, Lorraine R. Reitzel

Advances in Cancer Education and Quality Improvement

Objectives: Permanent supportive housing residents who have experienced homelessness use tobacco products at elevated rates, contributing to higher cancer risk. Agencies that provide wraparound support services to this group are committed to rebuilding their stability by improving their health. Yet, their delivery of tobacco screening and cessation care is limited, as is information about their clients’ tobacco use behaviors. Here, we evaluated a low-cost intervention for an Albert Schweitzer Fellowship project conducted in a permanent supportive housing program with 650 adults who had experienced homelessness in Houston, Texas.

Materials and Methods: Between August 2024 and February 2025, client-facing staff members …

Evaluation Of Shortened Irinotecan Infusion Times And Adverse Effects Incidence For Gastrointestinal Medical Oncology Patients, Rachel N. Ochs, Daniel J. Donovan, Neha A. Betrabet, Wendy M. Covert

Advances in Cancer Education and Quality Improvement

Background: Irinotecan, a topoisomerase I inhibitor, is commonly used to treat gastrointestinal cancers. The infusion time of irinotecan is usually over 90 minutes; however, studies support the safety and feasibility of 30-minute infusions. A shortened infusion duration may improve patient quality of life, optimize infusion chair utilization, and reduce wait times. Faster infusion rates may increase the risk of acute cholinergic side effects, reported in up to 50% of patients (all grades). Current institutional practice in the gastrointestinal medical oncology (GIMO) clinic involves administering irinotecan over 90 minutes and using atropine as needed for reversing cholinergic symptoms. For patients who …

Unlocking Faculty Potential: A Quasi-Experimental Study Of Coaching And Academic Performance In Health Care Settings, Amanda Woods Herron, Katelyn J. Cavanaugh, Michelle Figliuolo Deveau, Courtney L. Holladay

Advances in Cancer Education and Quality Improvement

As faculty in academic medicine face mounting demands to excel in clinical care, research, teaching, and administrative responsibilities, interventions that support professional sustainability are increasingly critical. Coaching has emerged as a promising developmental strategy within health care leadership, yet its impact on research and clinical outcomes in academic medical centers remains underexplored. This quasi-experimental study evaluated the effectiveness of a coaching program using intentional change theory (ICT) as a conceptual framework. ICT emphasizes sustainable personal transformation through alignment between the ideal self and professional goals. We examined a sample of 189 coached clinical faculty and 200 matched peers who had …

Why Should A Data-Driven Cancer Center Prioritize Well-Being?, Peter Pisters

Advances in Cancer Education and Quality Improvement

No abstract provided.

The Future Of Wellness In Health Care, Jennifer Bickel

Advances in Cancer Education and Quality Improvement

No abstract provided.

Actualizing Leaders To Inspire A Group Network (Align): Feasibility And Pilot Of Implementing A Commensality Group Program For Leaders In A Pediatric Healthcare Setting, Thomas B. Ayres, Kristin Ray, Angela Myers

Advances in Cancer Education and Quality Improvement

Background: Leadership behaviors in pediatric health care settings are strongly linked to leader burnout, professional fulfillment, and self-care in addition to influencing their teams. Despite their pivotal role, leaders often face substantial emotional burdens associated with their roles. Commensality groups, defined as small, recurring gatherings centered around shared meals and structured discussions, have emerged as a promising approach to enhancing connection, community, and resilience among health care professionals. A gap in the literature regarding commensality groups is understanding the mechanism of this well-being intervention. Our hypothesis is that commensality groups act as resource caravans and provide psychosocial resources to health …

Evaluating Electronic Health Record Intervention Efficacy In Enhancing Inpatient Initiation Of Guideline-Directed Medical Therapy, Sheraz Qamar, Trisha Sindhu, Charlotte Pirquet, Benjamin Richter, Charlotte Sacksteder, Tatianna Branch, Jeffrey Riggio, Cara Martino, Patricia C. Henwood, Alan Kubey

Department of Medicine Faculty Papers

BACKGROUND: Heart failure (HF) is a leading cause of hospitalization, morbidity, and mortality. Despite evidence supporting guideline-directed medical therapy (GDMT), prescribing remains suboptimal, particularly at hospital discharge.

PROJECT RATIONALE: Hospitalization provides an opportunity to initiate or optimize GDMT, but workflow barriers and practice variation limit implementation. To address this gap, our system implemented a system-wide HF quality improvement initiative featuring evidence-based order sets and an electronic health record smart phrase ("HFNOTE") to centralize and standardize documentation and encourage GDMT use.

PROJECT SUMMARY: We analyzed 2,859 HF hospitalizations across 10 hospitals between December 1, 2024 and June 30, 2025. Use of …

Ehr-Based Quality Interventions Associated With Differential Gdmt Prescribing In Community Versus Academic Hospitals, Trisha Sindhu, Charlotte Pirquet, Sheraz Qamar, Tanay-Veer Gandhi, Patricia C. Henwood, Cara Martino, Jeffrey Riggio, Jared Vanderzell, Charlotte Sacksteder, Alan Kubey

Department of Medicine Faculty Papers

BACKGROUND: Institutional barriers are associated with suboptimal guideline-directed medical therapy (GDMT) prescribing at heart failure discharge.

PROJECT RATIONALE: Practice variations between academic medical centers (defined as "teaching" hospitals with residents) and community hospitals are poorly understood. Evaluating how diverse settings respond to quality improvement strategies is vital.

PROJECT SUMMARY: A multicenter study across 10 electronic health record-unified hospitals evaluated 3,535 heart failure encounters. Phase 1 implemented educational work groups and financial incentives; phase 2 introduced clinical decision support systems. Community hospitals responded significantly to phase 1 education/incentives, with mean discharge of GDMT agents rising from 2.19 to 2.44 (P = …

Exploring Which Ehr Interventions Improve Heart Failure Hospitalization Outcomes Across 10 Hospitals, Sheraz Qamar, Andres Alvarado, Thomas Buckwalter, Patricia C. Henwood, Dana Jordan, Cara Martino, Jeffrey Riggio, Charlotte Sacksteder, Jared Vanderzell, Alan Kubey

Department of Medicine Faculty Papers

BACKGROUND: Heart failure (HF) remains a major cause of mortality and hospitalization despite advances in guideline-directed medical therapy (GDMT). Electronic health record (EHR)-based clinical decision support tools may improve care delivery, but their impact on outcomes remains ill-defined.

PROJECT RATIONALE: As part of a system-wide HF quality improvement initiative, we evaluated 2 EHR interventions: an evidence-based HF admission order set promoting early diuresis and GDMT optimization, and a templated HF documentation tool (HFNOTE) designed to capture clinical complexity.

PROJECT SUMMARY: We analyzed 4,865 HF hospitalizations across 10 hospitals between December 2024 and June 2025. Overall risk-adjusted mortality index was 0.83 …