Design:  Using the DMAIC methodology (a data-driven improvement cycle used for improving, optimizing and stabilizing processes), a quality improvement team was tasked to address the issues. The team consisting of leaders, nurses, physicians and administrative staff identified several contributing factors.

Main Findings:  Contributing to errors were: Issues related to practice standards, practice variation among providers and nurses, duplicate work, space limitations, lack of organization and culture. The team also noted volumes in the clinic had increased 45% over the previous 2 years, with no additional staffing resources.

Impact on Practice:  This work had a huge impact on staff and patients demonstrated by improved patient experience scores and improved staff morale. The team has a sense of ownership and pride that has resulted in a professional well organized clinic which meets all regulatory standards and requirements and as a result has seen a large reduction in dosing and administration errors. The development of a revised onboarding and competency program has also been key in supporting current and new staff joining the clinic in providing safe quality care.


Submitted by Sara Roebuck from Dartmouth Hitchcock Medical Center / Allergy and Immunology Clinic