Swafford Answers Questions about CS&E Program
Joseph Swafford, M.D., F.A.C.C, is professor of medicine, Department of Cardiology, and deputy division head, Division of Internal Medicine. He serves as a member of the Steering Committee and as co-medical director of the Clinical Safety and Effectiveness (CS&E) course. Dr. Swafford shares his thoughts about the CS&E program, his experience and views about its impact and its future.
Questions and Answers
How did you first learn about and become involved in the CS&E program?
Along with a few other staff, I attended the IHC (Intermountain Healthcare) course on performance improvement strategies at Salt Lake City, Utah. It was part of a master plan to involve M. D. Anderson employees to eventually grow our own program. The group of us took our combined knowledge and ideas and together launched the Clinical Safety and Effectiveness program in 2006.
What do you see as the future of the CS&E program?
Initially, I see a practical application of the program and a developing research academic component to the program. By that I mean that we hope to attract more faculty involvement into process improvement projects and help them better understand the process here at M. D. Anderson. Beyond that, and I think we are actually beginning to develop now, a research/academic avenue for CS&E alumni to become principle investigators on projects. That extended effort would be recognized and become an involved part of the faculty career development process. I also see a need for the principles of quality improvement and process improvement to be taught in the medical school curriculum and courses with the fellow and residency programs. A few fellows have taken the opportunity to become involved in the CS&E program, but I see the need for them to take that experience and knowledge to the principle investigator level during their residency and fellowship time here at our institution.
Secondly, I see the CS&E program being the catalyst for a change in culture at M. D. Anderson. The culture change I’m speaking of is a change of mindset to performance and process improvement throughout the institution in everything we do. We currently have the early adopters who have readily participated in the CS&E program. I see the future pulling in those individuals who may have had some hesitation about this process and the impacts. These are the same people who hold time commitment to something new a little closer to their chest per se, until the benefit is clear enough that it overcomes the time commitment cost. We also have a time and funding challenge for alumni to step into the role of principle investigator on expended projects. The time challenge involves securing protected time to do the projects and time to write grant proposals and publishable papers.
What do you mean by "principle investigator level"?
Principle investigators are individuals who are leading research efforts that are funded by either the federal government or other funding sources. There are increased opportunities for funding of quality improvement and process improvement projects. Alumni would continue their CS&E projects in an expanded funded effort as the principal leaders / investigators. Frequently the diagnostic journey in these quality improvement projects leads to new insights and to new questions which then lead to other clinical research studies. If the evidence from the research studies proves beneficial, then it leads to the next QI project of getting it into the standard of practice. This idea supports the number one and number two institutional strategic goals that speak directly to enhancing the excellence, value, safety and efficiency of our patient care and enhancing the quality of existing research programs for the future.
What do you see as CS&E’s greatest asset?
That’s a good question. I believe the greatest asset of the CS&E program is its ability to show how the program works and has been incorporated into and throughout our institution for great benefit. Our CS&E program now serves as the standard and model for other programs. Brent James was the originator and inspiration for our program’s development. Now our own program and projects are inspirational to others. I guess in two words, I’d have to say: "It’s real!"
What benefits have you received from being a part of the CS&E program?
My entire perspective on medicine has changed. Before, I was very clinically focused and looked at the one-on-one care with patients. Now, I look at the entire picture from a 10,000-foot level view. I see how we can improve the entire system and processes to do a better job versus how do I do a better job.
I’d also like to mention how this program has changed our division. Starting in May of 2007 our division developed QI (quality improvement) officers for each department and we developed a QI council for the Division of Internal Medicine. The council members have attended the CS&E courses and created our mission statement that we are very proud of. I’ll share it with you:
The Division of Internal Medicine (DoIM) Quality Council seeks to create a culture of quality by developing an infrastructure that focuses on data-driven innovation, evidenced-based care, education, patient safety and research. The council works toward the development of a customer-based approach for delivering superior services to M. D. Anderson patients and employees, and to the community. The mission of the council integrates with the mission of M. D. Anderson by providing outstanding quality and integrated programs in patient care and by implementing those programs with integrity, consistency and excellence. The council will achieve its mission by:
- Providing a forum and framework for internal and external collaborative efforts toward quality initiatives
- Facilitating the development of quality improvement plans for departments and centers within DoIM
- Facilitating the provision of skills and resources towards successful implementation and monitoring of those plans
Is there anything else you’d like to say to the newsletter readership?
I’d say to the alumni, "Make the experience more than just a course that you’ve taken, make it how you view medicine."
To the current and future CS&E program participants I’d say, "Give it a chance, I’m certain your focus will change for the better!"
Thank you, Dr. Swafford, for the time you’ve taken to speak so candidly about the CS&E program, its benefits, where you see it going, and to encourage all of us to gain that bigger perspective of how our efforts affect and help the whole.