Advanced Practitioners as Agents of Change: Leveraging Quality Improvement to Improve Practice

Scientific innovation in hematology and oncology is constant and increasingly complex, requiring individual clinicians and institutions to effectively integrate standards of care across the diverse hematology and oncology landscape into practice. Effective integration of evolving diagnostics, risk models, new therapeutics and novel treatment strategies, and practice regulation requirements requires ongoing practice improvement efforts and an infrastructure to implement change. Advanced practitioners (APs) are poised to serve as agents of change based on their clinical presence, clinical expertise, familiarity with critical members of the interdisciplinary team, communication skills, and ability to envision and actualize optimized workflows. Through practice analysis, workflow optimization, role delineation, and effective utilization and tailoring of documentation in the electronic health record, APs can lead implementation strategies to improve patient outcomes. In this article, we will review the essential role APs play as agents of change to implement best practice models using quality improvement (QI) processes. The principles of QI as a strategy for practice improvement, including strategies and tools for successful practice analysis, workflow optimization, outcome analysis, implementation, and sustainability of change, will be reviewed. Proposed elements of a QI and practice integration toolkit for APs and a series of QI exemplars, including an Advanced Practitioner Society for Hematology and Oncology (APSHO)-led QI initiative and AP-led QI initiatives, will be summarized.