QI, QA and Research

Do you have to or want to write a proposal for a project in QA, QI, HCAHPS, QPI, JCAHO, safety, patient satisfaction, or any of the other new requirements? I thought to share some time-tested tips after I received a call from an RN in Labor and Delivery: She knew first hand how well mind-body interventions work and would like to introduce Comfort Talk® in her unit. Her supervisor suggested for her to use the topic for an HCAHPS project and write a proposal. This may seems daunting if one has never done it before. Here is what I learned the hard way over the past 20 years through a successful history of federal funding and clinical trial experience.

• Writing a grant or proposal is not for the faint-hearted. Choose a topic you are passionate about and believe in. It will keep you going when the going gets tough. Persistence will pay off. And keep in mind: Producing the data is often the only way by which you can bring a change about the delivery of care and make your environment more pleasant.

• Choose something you wonder about in your daily practice – how something actually works or could work much better if… Remarkably a lot of what is done in clinic is often not questioned and just some tweaks can make practice better and safer. A few examples are listed below (1-14).

• Expect some jabs and opposition. I got a lot of ridicule when I first started looking into guiding patients with self-hypnotic relaxation on the OR table in Interventional Radiology. Then an earthquake at the west coast eliminated the recovery space at the hospital – and suddenly these methods became choice to keep IV conscious sedation rates down. And 20 years later the patient experience is now a hot topic.

• Make interdisciplinary alliances. The best projects include different specialties or professional groups. You will find like-minded people that can bring very different aspects to your work. Together things become possible none of you could have done alone. It is also a great way to meet new people you might not because as a medical professional to interact mainly with coworkers and colleagues. As such, I have met and worked with hydraulic engineers, metal experts, public health experts, business school people, psychologists, software engineers, app designers, educators, addiction experts, hospital financial analysts, managers, dentists, statisticians, and best of all my husband (a biochemist).

• Don’t be shy and contact the people you would like to work with. You may be surprised how willing strangers will be to help you out. And if you listen to their advise and work diligently on your project they will also be there for you when things get tough. There have been a few times when I was ready to get out of the whole hypnosis – Comfort Talk® project. Support from friends and collaborators then kept me going.
• You may wonder how to get it all done since the day is already chuck-full with other obligations. Here is some advice from Robert Berkley, an Executive Coach and his wife, brilliant Women-on-Fire founder Debbie Phillips: Work in 20-minute spurts. For just 20 min work intensively on your project. Then do something completely different – stretch, walk around, lift a dumbbell, do email, errands, phone calls, or other jobs, or look out a window if your area has one or just close you eyes and take short meditative break. Repeat. It is easy to bribe oneself for “just” 20 minutes and it is also remarkable how much else “minor stuff” gets done like that and how relieving that is.

Just to show that I live my own advice. I got a 92-page grant out this weekend. Was it drudgery – ohhhh yes. Did I love it? – weirdly so, nevertheless. The proposal helped me shape my mind and focus about what I am passionate about now: Preventing opioid addiction before it happens by promoting pain management upfront at first contact with the patient. The goal is to empower the patient with coping skills to reduce pain, anxiety, and need for opioids before addiction occurs. And when that happens it will be rally sweet and made it all worthwhile. Unless forced to really think about how to proceed I might not have done so. And then when your goal comes through it just feels good.

 

References

1. Lang EV, Barnhart WH, Walton DL, Raab SS. Percutanous pulmonary thrombectomy. J Vasc Intervent Radiol. 1997;8:427-32.
2. Lang EV, Carson L, Gossler A. Gas lock obstruction of the colon. The Ogilvie syndrome. AJR. 1998;171:1014-6.
3. Lang EV, Chen F, Fick LJ, Berbaum KS. Determinants of intravenous conscious sedation for arteriography. J Vasc Interv Radiol. 1998;9(3):407-12.9618098.
4. Lang EV, Fick lF, Barnhart WH, Gossler AA, Lacey D. Factors affecting bolus configuration during CO2 arteriography. J Vasc Intervent Radiol. 1999;10:41-9.
5. Lang EV, Hatsiopoulou O, Koch T, et al. Can words hurt? Patient-provider interactions during invasive procedures. Pain. 2005;114(1-2):303-9.15733657.
6. Lang EV, Laser E. Communicating with the patient. Luxury or necessity ? Acad Radiol. 1996; 3:786-788.
7. Lang EV, Laser E. Training interventional radiology personnel in nonpharmacologic analgesia. Radiology. 1996;201(P):214.
8. Lang EV, Laser E, Anderson B, et al. Shaping the experience of behavior: construct of an electronic teaching module in nonpharmacologic analgesia and anxiolysis. Acad Radiol. 2002;9(10):1185-93.12385513.
9. Lang EV, Rosen MP. Cost analysis of adjunct hypnosis with sedation during outpatient interventional radiologic procedures. Radiology. 2002;222(2):375-82.11818602.
10. Lang EV, Yuh WT, Ajam A, et al. Understanding patient satisfaction ratings for radiology services. AJR American journal of roentgenology. 2013;201(6):1190-5; quiz 6.PMC4427188.Nihms683140.24261356.
11. Flory N, Lang EV. Distress in the radiology waiting room. Radiology. 2011;260(1):166-73.PMC3121015.21474702.
12. Bookstein JJ, Lang EV. Penile magnification pharmacoangiography. Details of intrapenile arterial anatomy. AJR. 1987;148:883-8.
13. Carson L, Lang EV. Percutaneous colostomy for treatment of mechanical bowel obstruction: Factors affecting feasibility. J Vasc Intervent Radiol. 1996;7:561-7.
14. Lang EV, Berbaum KS, Lutgendorf SK. Large-core breast biopsy: abnormal salivary cortisol profiles associated with uncertainty of diagnosis. Radiology. 2009;250(3):631-7.19244038.