Quality Management and the Respiratory Therapist

 Updated: July 11, 2018

  Tags: Quality Management

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Quality management is a key component of healthcare, and respiratory care managers play an integral role in making it happen for their departments. What are they doing and why? Several managers weigh in.

Measurements are crucial

Holly Tull, BASM, RRT, respiratory care manager at Virginia Mason Memorial Hospital in Yakima, WA, believes respiratory care departments should be looking at everything from ventilator protocols to nebulizer treatments to infection control and should be using value analysis to make decisions on the products and services they bring in to the hospital.

“In the end, good patient care usually means that the patient gets what they need, when they need it, and will use your hospital wisely as you have educated them on when to call a doctor so many things can be dealt with on an outpatient basis,” Tull said.

Susan Barlow, MHA, RRT, CPHQ, director of respiratory care, the pulmonary lab, and hyperbarics at Jackson Health System in Miami, FL, says it’s vital that RTs take part in quality and metrics.

“We are probably involved every day and may not realize how much. As a leader, measurements are crucial to be able to compete in today’s market,” Barlow said.

Indeed, she went after her CPHQ — Certified Professional in Healthcare Quality — credential for that very reason and believes it has helped her better understand what it takes to manage quality improvement projects.

Perfect mechanism

“Quality improvement is the perfect mechanism by which departments can demonstrate their contributions and value to all of those touched by respiratory care — patients, peers and colleagues, staff, physicians, and administrators,” said Tom Malinowski, MSc, RRT, FAARC, director of pulmonary diagnostics and respiratory therapy services at the University of Virginia (UVA) Medical Center in Charlottesville.

UVA uses the Lean methodology version of the PDCA — plan, do, check, act — along with A-3 thinking, Standard Work, Root Cause Analysis, and team member solution methods to resolve issues. It’s all dubbed the “Be Safe” approach and is driven by staff engagement.

Respiratory therapy tracks various key processes and Malinowski says they are all displayed within the department’s own balanced scorecard.

“Clinical staff see the direct connection between the work being done at the bedside, departmental performance, and organizational quality,” Malinowski said.

Creating positive change

Ken Stanford, RRT, manager of respiratory care at Bassett Medical Center in Cooperstown, NY, says all of his staff members are required to work on a process improvement project throughout the year.

“Sometimes we have a perception that a process is broken or can be improved upon,” he said. “If staff are allowed to work on what they believe to be important and their hard work creates positive change for their patients or workflow they feel rewarded and it doesn’t feel like a burden.”

Many of the projects end up being reported to other hospital committees, as well as to the Quality Management Council (QMC), and he believes these honest and transparent reports showing vulnerability and opportunities, as well as successes, are a great way to make the department stand out in the organization.

According to Stanford, since the QMC consists of hospital executives, it also gives him the chance to show the C-Suite how respiratory care is doing “so much more than deliver great bedside care.”

Marketing your team

At Rush Copley Medical Center in Aurora, IL, Respiratory Care Services Manager Ruth Karales, BS, RRT, and her staff participate in a number of process improvement projects too.

“Reviewing current practice, then having this become your Quality Improvement/Practice Improvement, you are able to process improve and then market your team as an essential positive force to provide evidence-based care and cost measures, keeping the quality goal first,” Karales said.

Respiratory therapists at her hospital gather information on new products and compare pre/post-trial data, follow an order set for Bi-Pap patients and monitor compliance, and monitor the time and number of re-taping events in the NICU to improve skin care, decrease unneeded re-taping, save staff time, and limit unplanned extubations.

Formal training program

Quality and safety go hand-in-hand at the University of Alabama (UAB) Hospital in Birmingham, says Respiratory Care Manager Robert B. Johnson, MS, RRT.

The commitment is so strong, in fact, that UAB sends all of its management team members, from supervisor on up to the UAB Healthcare Quality and Safety Graduate Certificate Program.

“The program consists of four Master level classes — 15 credits — in one semester,” Johnson said. Most are online, but there are some weekend classes as well. He and seven other respiratory care management team members have gone through the training.

“During the classes, they gave us the tools to develop, measure, and implement a quality improvement program,” Johnson said.

He says they all use the knowledge they gained in the course on a daily basis. It figured heavily into a recent quality improvement project on lowering the number of ventilator days in the facility.

“Our vent days were 8.88 — that is high even for a large academic medical center with 11 ICUs,” Johnson said.” Thanks to the quality improvement initiative, over the past 12 months vent days have dropped to 4.66 on average.

“Quality improvement is another way the hospital sees the respiratory care team as a valuable member of the overall healthcare team,” Johnson said.

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