Leading with the heart led to trust
by Kilian Kimbel, 2019
I started working on the Healthy Hearts Northwest project in 2015. In my 11 years with Kaiser Permanente Washington Health Research Institute, I had never worked on a quality improvement research project, let alone one invested in recruiting and providing practice facilitation with over 250 small- to medium-sized primary care clinics spread across the Pacific Northwest within 3 years! This work has deepened my knowledge of research, taught me about health care practice transformation, and showed me that each are profoundly human at core.
One of my first roles was tracking and managing the study’s survey data collection alongside other team members. Although my heart has some sort of affiliation for wanting to input numbers and formulas into tiny boxes, I didn’t realize just how close to the data I would get.
I reached out to our enrolled clinics to remind and encourage them to fill out surveys. Compared to my previous experience interviewing patients, it was much more complex to ask busy provider teams to fill out multiple, lengthy instruments they sometimes didn’t have the ability or capacity to answer. Our enrolled clinics fielded big asks daily, and I learned that at the end of the day answering research questions might not be a priority for busy practitioners.
Besides ensuring practices had practical and applicable incentives for completing surveys, I also tracked response rates and held a close watch on the data itself, posing questions to our practice facilitators (PFs, or coaches) as needed. My favorite part of data cleaning was reading open-ended responses. These are generally at the end of a survey and provide opportunity for respondents to say what they really think. These are included in surveys so that researchers might gain better understanding of context, as well as limitations of the instrument itself. Open-ended responses can also shed light on external factors such as lack of resources outside of the respondent’s control, which may not be reflected in the 1-10 scale.
Here are some quotes from our baseline practice and staff member surveys:
- “Some questions were impossible to answer. Staff are too busy to track down to get information. I don’t know how to run reports for some of the information requested and don’t have the time to research how to do it. We are an office of 5 in total.”
- “Sorry, but I do not have a report that shows me the demographic breakdown of our patients.”
- “We do not have reports available to us to accurately complete all of the requested information.”
After I read these I wanted to say to our study’s principal investigator: “This isn’t going to work! How can we expect practices to complete a survey that requires them to access data they don’t have the ability to pull, and not because they don’t want to, but because they simply don’t have the resources or assistance to do so?”
I couldn’t know at that time that these answers would aid in the project’s understanding of practice abilities, barriers, goals and aspirations, and that they would create a direction for quality improvement. It’s important to note that survey feedback also touched on positive themes:
- “We believe we provide exceptional care, however we do not have a consistent method of tracking and reporting the care we provide. We are excited to work together with Healthy Hearts to improve the care we provide and the methods with which we gather and report that data.”
- “Change is difficult, but we have had a lot of changes in a short time, after the negative attitudes dispel the clinic, we will get the work done and changes will happen, continued encouragement may be needed in the beginning.”
- “Our staff do follow medical guidelines and best practices we simply don’t have all the policies and procedures for medical care we want in place, but the medical staff are all on board with establishing and helping develop these for our practice.”
I felt encouraged by that input to continue reminding practices to complete their surveys. By remembering that continued encouragement could lead to change, I was able to connect my work to the project’s quality improvement strategy. That helped me to trust the process. I learned not to expect immediate engagement, nor to interpret engagement levels based on low (or slow) survey response rates.
In addition to supporting multiple practices on many different levels, our practice coaches took on the role of survey data collectors. They were the unspoken heroes on our project – as messengers of our research agenda, and as teachers that persevered and opened doors to contributions that spread from clinic to clinic. As we neared the end of survey data collection and I read the second set of survey responses, the coaches’ magic and the value of clinic participation in Healthy Hearts Northwest (H2N) became clearer to me:
- “Very helpful to have Healthy Hearts NW to be involved and support us with outside resources, graphs, and comparison with national averages, encourages us to improve!”
- “H2N has been a delight to be affiliated with. Professional and devoted staff that help with a wide array of modern clinical and technical challenges.”
- “A slow start but overall a great program. Really helped the team focus. Facilitators were able to help the team think out of the box and also see the positives. Thanks!”
I jumped into Healthy Hearts Northwest feet first, not knowing what would or could happen, and in the end survived! Despite the hurdles, and competing priorities and barriers, I saw that change happened, slowly but surely. I believe everyone on our team helped someone or something to change.
I witnessed our incredible coaches have magical impact on clinics in Washington, Oregon, and Idaho and I’m hopeful that the knowledge they shared won’t be forgotten. This project reinforced for me just how powerful simple acts of support are. And how every heart needs kindness.
“Thank you, Healthy Hearts, for helping us to come together monthly, opening up dialogue and supporting us through our growing pains. Also all the IT help. It is invaluable. I feel you have helped us be better practitioners, better nurses, and better overall: We will surely miss our monthly meetings with. We will carry on with our monthly meetings when you are gone because we recognize the value in them. Taking time for the betterment of all is valuable.” — Healthy Hearts NW clinic
Kilian Kimbel, BA, is a research specialist at Kaiser Permanente Washington Health Research Institute and former research interviewer in its Survey Research Program.