Author: Natalie Sanfratello, MPH, CHCP
Introduction
Building Stakeholder Engagement into Quality Improvement (QI) from Day 1
Your Core QI team has prioritized some intervention ideas, and now you need buy-in from the frontline clinicians to test them. Without buy-in, these changes won’t stick. Here, is where educational opportunities, designed to improve knowledge, competence, and performance, can make a difference. While QI initiatives may have a single educational session at the outset to close knowledge or competence gaps hindering meeting the aims, there are many other points along the way that can help to keep folks engaged, excited, and allow their voices to be heard. And all of these can be done in the context of educational sessions.
As CE/CPD providers, we are in a unique position to embed high-quality education throughout the QI continuum. These opportunities to engage with the doers in the system create a feeling of shared ownership, provide safe spaces for clinicians to ask questions, incentivize engagement in the interventions, and demonstrate institutional investment in the learning process rather than just the metrics. Now you may be asking, when should we be integrating education in a QI initiative? To provide an example, I outlined what worked for us in a quality improvement initiative to improve cognitive screening for individuals aged 65 and older in a family medicine clinic. This initiative ran from March 2024 through August 2025, and we provided three accredited continuing education sessions. Here is how they unfolded.
- Session 1: April 2024 (grand rounds). We covered the current prevalence of Alzheimer’s disease and related dementias (ADRD), and why screening matters in primary care along with the current tools available in the electronic health record for completing the screenings. We asked clinicians about their barriers (a crucial component). This real-time feedback validated our current state assessment and surfaced priorities the team had not fully appreciated. Clinicians felt heard from day one, and screening rates ticked up immediately before we even launched the main interventions.
- Session 2: August 2024 (nurse in-service). Clinicians made it clear that their main bottle neck for screening was the lack of time they had during appointments. Inspired by the Geriatrics department, we shifted cognitive assessments to nurses. Before rolling it out, we hosted a hands-on in-service which combined didactic content with practice. This positioned nurses as essential to the initiative and gave them skills and confidence, leaving them feeling well-prepared and valued.
- Session 3: July 2024 (multi-site grand rounds). After all interventions were live, we hosted a culminating grand rounds session across multiple sites. We presented results, heard final feedback, and celebrated what the team and clinic had accomplished. This also planted seeds with other clinics about beginning their own initiatives.
Along with these accredited sessions, our champion provided brief updates to the clinic on a regular basis through their provider meetings. This information was shared whenever there were new interventions, updates on data, and they were designed to gain additional feedback on interventions as they were evolving.
Education can provide an infrastructure within Quality Improvement (QI) initiatives. Layering accredited sessions throughout the initiative can shift clinicians from bystanders to partners. While educational interventions alone are generally considered a low leverage intervention, when used intentionally and in conjunction with systems-based interventions, they can be even more effective in changing attitudes and engaging stakeholders.
- Education alone is unlikely to change practice or allow for meaningful quality improvement
- The program described involved three interactive sessions around dementia screening in a primary care clinic which included feedback from health care professionals
- Interventions were tailored based on feedback and regular updates were provided to the health care team
- This iterative, feedback-driven approach transformed clinicians from passive observers into active partners in the quality improvement process.
Summary / Key Takeaways:
- Education alone is unlikely to change practice or allow for meaningful quality improvement
- The program described involved three interactive sessions around dementia screening in a primary care clinic which included feedback from health care professionals
- Interventions were tailored based on feedback and regular updates were provided to the health care team
- This iterative, feedback-driven approach transformed clinicians from passive observers into active partners in the quality improvement process.
