[On screen: Logos for QI HUB, The Ohio State University College of Medicine, and The Ohio State University Wexner Medical Center.
Text on screen:
Presents: Mixed Methods Approach for Healthcare Improvement]
 
J.J. Kuczynski, PT, DPT, LSSGB: There are many improvement methodologies that can be used to support health system efforts toward improving operations, patient outcomes, and team member experiences. 

[Animation: A person standing next to a large thought bubble with a blue icon of a central gear with a network of lines around it. A grey circular arrow diagram appears on screen and overlaps the blue icon. An outline of 4 medical professionals with lab coats and stethoscopes also appears and overlaps the two icons.]

In many cases, the improvement frameworks and tools people within a health system use are largely influenced by the methods they were exposed to during their training, or those used most often by their closest peers and colleagues. 
George E. Box, a statistician who famously worked in quality control, said all models are wrong, but some are useful. In the realm of academic healthcare, a mixed methodology approach emerges as a powerful strategy for quality and operations improvement and finds a way to make many improvement models useful. 

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- Change management
- Model for Improvement
- Six sigma
- LEAN
- Evidence-based practice
- Implementation science]

Combining the strengths of various improvement methods within healthcare can enable a healthcare team to better execute its top priorities. In this video, we will introduce several common methods and tools that are often used to support quality, process and improvement activities. When used alone and in the right context, each of these models can be quite useful, but when used with a more complementary and integrated approach, the most effective and transformative solutions and outcomes become even more possible. 

The model for improvement from the Institute for Healthcare Improvement, or IHI, is a systematic framework designed to enhance healthcare processes. Its three fundamental questions, what are we trying to accomplish? How will we know that a change is an improvement? And what changes can we make that will result in improvement? Guide healthcare teams in setting goals, measuring progress and implementing changes. It promotes a structured and iterative approach to foster continuous improvement in healthcare delivery. 

A core tool in this approach is the Plan, Do, Study, Act, or PDSA cycle, which promotes rapidly testing ideas and making small changes along the way. The versatility of the PDSA approach pairs well with the often-nuanced context of academic healthcare. 

Next on the list is Six Sigma, known for its data driven precision and emphasis on reducing variation. Built on the steps of define, measure, analyze, improve, and control, or DMAIC, this can be paired with the adaptability of other methods and supports a comprehensive approach. When statistical rigor meets the flexibility of mixed methods, it provides a strong strategy for addressing complex challenges and improves the odds of real-world implementation success.

[Animation: Five circles appear on screen with the text, Task 1, Task 2, Task 3, Task 4, and Task 5 inside of each one. The words, “Not necessary” appear on screen with arrows pointing to Task 2 and Task 4. These two circles disappear off screen, and the three remaining circles have the text, Task 1, Task 2, and Task 3. 

Lean methodology has distinct emphasis on eliminating waste and enhancing value adding activities. Beyond simply streamlining processes, it becomes an incredibly useful approach when partnered with other methods, such as evidence-based practice. This allows us to gain insights from both quantitative data and qualitative experiences within healthcare, ensuring that efficiency efforts are grounded in a deeper understanding. 

Evidence-based practice, or EBP for short, is vital to any high performing and sustainable healthcare operation. EBP involves asking focused clinical questions, acquiring and appraising relevant evidence, and applying it alongside clinical expertise and patient values. This cyclical process ensures informed decision making with ongoing assessments and adjustments based on outcomes and evolving evidence. This helps promote continuous improvement within clinical practices. It's not just about adhering to evidence. It's about understanding how evidence aligns with the intricate context of healthcare, ensuring a more thorough approach. 

Implementation science is the study and application of methods to promote the systematic integration of evidence-based practices in real world settings. It focuses on bridging the gap between knowledge and practice, understanding the factors which influence successful implementation, and enhancing the adoption of tested interventions. 

Lastly, change management in healthcare is a structured approach to implementing and managing change within organizations or teams. It involves planning, communicating, and executing changes while minimizing resistance and maximizing adoption. In healthcare improvement, change management is crucial for integrating new practices, technologies, or workflows successfully.

In conclusion, a mixed methods approach stands out as a versatile and impactful strategy for healthcare improvement. Much like having a toolbox containing a variety of tools, allows someone to address various projects with different needs and constraints, combining the strengths of various improvement methods offers a more complete solution to address unique challenges and complexities in the academic healthcare environment.

[On screen: Logos for QI HUB, The Ohio State University College of Medicine, and The Ohio State University Wexner Medical Center.
Text on screen: Thank you!]
[QR code links to: https://go.osu.edu/qihub]