Meghan Johnson

Improvement - A Philosophy to Live By

Posted January 11, 2014 by Meghan Johnson, MSc

This was originally posted October 2013

For as long as I can remember, I have been working to make things more organized, effective and efficient. I have spent countless hours organizing and reorganizing things in my life – everything from my son’s toys and games to the storage of our digital photos. It shouldn’t be surprising, then, that I have spent over a decade in project management and just over a year ago, found my way to NICHQ and discovered quality improvement science.

I just never suspected how much this work would transform my daily life.

I started to be convinced when I saw the remarkable progress hospital teams are making in a NICHQ collaborative I help lead to improve care for children with autism spectrum disorder (ASD). Families of children with suspected or diagnosed ASD frequently face significant barriers in obtaining access to healthcare services. This is a critical issue because delays in access mean delays in diagnosis and early intervention – vital services to improve treatment outcomes.

Two of our teams, Cincinnati Children’s Hospital Medical Center (CCHMC) and Nationwide Children’s Hospital, have been working hard to address this issue and the results are impressive:
  • CCHMC has decreased the wait time to see a physician by an average of 68 percent for children under 5 in its ASD clinic.
  • Nationwide has decreased its waitlist for ASD follow-up visits by 96 percent. 

These dramatic improvements mean children receive earlier diagnosis and treatment and better care experiences. For parents, it means fewer questions and more answers. These improvements were achieved using basic principles of improvement science – developing and testing small system changes, collecting data over time to assess whether the changes led to improvement, and finally implementing the changes to ensure they are sustained.

It wasn’t until I came to NICHQ and started witnessing transformational change like this that I realized my personal efforts at reorganizing things in my life were actually disorganized and unsystematic. I have learned that improving systems is a science. There is a logical, ordered series of steps that will truly lead to more efficient and effective systems.

It came full circle for me when NICHQ launched a unique learning opportunity for staff to hone our skills in quality improvement science and enhance our technical expertise. I took on a personal improvement project to increase my satisfaction with our home by completing three small home improvement projects by October 1, 2013. We moved into a new home a year ago with hopes of completing several projects shortly thereafter. But the work remained undone and I was feeling unsettled and unhappy about this constant state of disorganization. Quality improvement provided a disciplined approach to identify the constraints in our family “system” that were preventing my husband and me from completing this work. It also enabled us to test changes to accelerate our progress and ultimately implement changes that will sustain our improvements.

One of the primary barriers we identified was the lack of focused time to do this work, as we both have fulltime jobs and our young son keeps our evenings and weekends busy. So, we conducted a series of small tests to see if we could incorporate home improvement projects into the work week and weekends. In the end, we were able to increase the amount of time available for this work to at least two hours per week through improved time management. As a result, we now have a new ceiling on our porch, a freshly painted bathroom and a new dining room chandelier.

All of this has caused me to think more deeply about how to apply improvement theory in my daily life. It may sound odd, but I have tortured my husband and preschooler with questions such as “How can we do this better? What do you predict will happen? What should our next test of change be?” As a family, we have experienced first-hand how hard it is to change a learned behavior. We have learned to start our tests small and to celebrate our successes.

In improvement work, you learn as much from your failures as from your successes. Whether it’s finding a better way to manage family time or improving care in a huge hospital system, the same improvement principles apply. As a mother, I have a deep respect and appreciation for the changes our improvement teams are making and I hope all children will ultimately benefit from their hard work and dedication. And as a self-proclaimed organization hound, I will never approach a project in the same way again.


Add your comment





breastfeeding infant health Best Fed Beginnings Ten Steps to Successful Breastfeeding quality improvement QI tips sustainability NICHQ leadership Berns CoIIN infant mortality stress prenatal care data data capacity QI epidemiologists surveillance data smoking cessation PFAC medical home Baby-Friendly community partners safe sleep social determinants of health preconception and interconception care motivational interviewing Native Americans vulnerable populations sickle cell disease SCD parent partner patient and family engagement ADHD NICHQ Vanderbilt Assessment Scale ADHD Toolkit patient engagement quality care system design care coordination skin to skin newborn screening asthma LARC ASTHO reduce smoking aim statement safe birth Ten Steps Texas Ten Step perinatal regionalization skin-to-skin contact 10 Steps staff training small tests PDSA acute care disparities mother-baby couplet collective impact population health preconception interconception health National Coordinating and Evaluation Center Newborn Screening Program substance abuse breast milk formula milk bank crisis video Huffington Post fundraising campaign first responders SIDS SUID team turnover fatigue burnout Lamaze NYC patient tools patient transformation facilitator improvement collaboration healthcare health system health equity innovation design thinking learning collaborative best practices leadership engagement buy in CYSHCN medically fragile chronically ill cartoon obesity healthy weight clinic nutrition counceling healthy weight plan sickle cell diease treatment protocol prenatal education family engagement family health partner positive deviance diabetes public health evaluation maternity care healthy start Childrens Health Collaborative Improvement and Innovation Network Health Outcomes Measurement Cross-Sector Collaboration Improvement Science Knowledge Sharing Bullying Child Health Healthy Living Mental Health Prevention Childhood Obesity Health Disparities Quailty Improvement Systems Change Systems Design Advocacy Health Policy autism ASD