A Humanistic Approach to Improvement: The Multiple Sclerosis Continuous Quality Improvement Collaborative Coaching Approach.

Abstract

Background: Multiple sclerosis (MS) is a costly, chronic, complex condition, which requires customization of care at the system level to achieve better outcomes. The authors describe a cluster-randomized, coach-supported quality improvement (QI) intervention in the MS continuous QI (MS-CQI) Collaborative, which was a multicenter learning health system (LHS) study to improve MS outcomes (2018-2022).

Methods: The authors developed a coach-supported QI intervention within the MS-CQI LHS, which included aspects of standard QI approaches utilized in health care. This included a 12-step standardized QI Toolkit; team coaching twice monthly; team capability assessments; and patient-reported and clinical feedback data provided by the MS-CQI data registry. Assessments helped the coach understand clinic culture, readiness for change, QI skills and knowledge, and progress over time. The coach monitored and guided team activity and assured general adherence to the 12-step improvement process. Teams selected local QI activities within those constraints.

Results: A total of 3 out of the 4 MS-CQI centers were cluster randomized to the intervention and completed the study. Initial QI assessments revealed that teams perceived QI as important but had low initial skill and knowledge levels. Improved QI skills, knowledge, and engagement in the intervention improved, as teams realized ownership and perceived benefits.

Conclusions: The coach-supported QI intervention demonstrated basic feasibility, acceptability, QI skill advancement, and utility in the MS-CQI study. It is an example of an LHS-enabled humanistic (QI team-focused) intervention, which invests in developing capability of people involved in QI work.