Practical Insights on Clinical Process Improvement

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This podcast series aims to highlight the science, psychology, and strategies behind the practice of dietetics. Moderator, Lisa Jones, MA, RDN, LDN, FAND, interviews prominent dietitians and health professionals to help our community think differently about food and nutrition.

In this episode, Lisa Jones interviews Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, about tracking nutrition care outcomes and advancing evidence-based nutrition practice research. This is episode 4 of a 4-part series. 

Additional Resources:

Academy of Nutrition and Dietetics. Accessed July 19, 2023. https://www.eatright.org/

Commission on Dietetic Registration. Accessed July 19, 2023. https://www.cdrnet.org/

ANDHII. Academy of Nutrition and Dietetics. Accessed July 19, 2023. https://www.eatrightpro.org/practice/research/about-dietetics-research/andhii

Listen to episode 3 of this 4-part podcast series here.

Lisa Jones, MA, RDN, LDN, FAND, is a registered dietitian nutritionist, speaker, and author (Philadelphia, PA).

Sherri Jones, MS, MBA, RDN, LDN, SSGB, CPHQ, FAND, is the Quality Manager at the University of Pittsburgh Medical Center (UPMC) Presbyterian Shadyside working in the Department of Quality Improvement (Pittsburgh, PA), a member of the Academy of Nutrition and Dietetics Board of Directors, Director of the Academy’s House of Delegates, and a member of the House Leadership Team. 

TRANSCRIPTION: 

Speaker 1:

Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietician and nutritionist Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.

Lisa Jones:

Hello and welcome to Nutrition411: The Podcast, where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's podcast is part of a series of short episodes on clinical process improvement featuring a Q&A with Sherry Jones. I want the opportunity to introduce Sherri. First of all, Sherri, thank you for being here.

Sherri Jones:

You're welcome.

Lisa Jones:

Yeah, we're excited to have you today. Sherri Jones has been a registered dietician nutritionist for 35 years and is currently the quality manager at the University of Pittsburgh Medical Center Presbyterian Shadyside, working in the Department of Quality Improvement. In this role, she manages seven full-time quality improvement specialists who are responsible for value-based care measures and quality score scorecard outcomes. Sherri has worked in the field of quality improvement since 2012 and achieved her Six Sigma Green Belt in 2015. She's also a certified professional in healthcare quality national certification in 2020. And you can read Sherri's full bio on our website.

So again, welcome, Sherri. We are excited for you to be here. This is the fourth episode that we've had Sheri with us. She's given us such excellent information on clinical process improvement. And if you can summarize, Sherri, the conversation that we had on our previous episode, what would you say would be the key takeaways? I know what my key takeaway is, but I want to hear what yours is first.

Sherri Jones:

Say that it's really looking at what problem you're trying to solve or looking at your trends or whatever your quality or process improvement initiative may be. Sometimes it's not always solving a problem, it could be implementing something new. But in that planning phase of any improvement methodology that you're utilizing is to identify the key stakeholders, as we call them, in quality improvement. So who are the people that will play a role in your initiative, either directly or indirectly, and make sure that they are a part of the planning phase, as well as identifying who the key champion can be if it's a clinical project to find a provider, a physician, or an APP that can be your champion for your clinical initiative?

Lisa Jones:

Well, there you go. You said it. You said my favorite part, which was finding that provider champion. So thank you for reminding us about that. Let's dive into practical insights. And my first question for you, Sherri, is as dieticians, we are constantly on the lookout for ways to improve the clinical process and then optimize nutrition strategies for our patients. What would you say are some practical insights and nutrition strategies that we can then implement to streamline our clinical process and maximize patient success?

Sherri Jones:

Well, I would say, and I'm a strong proponent, I say this all the time to my quality improvement staff and other folks that I coach and mentor on their journey of quality and process improvement, is to work smarter, not harder. See what else has been done out there with regard to what you want to implement. Other people have tried these things. Look at the literature, do a literature search for whatever you looking to implement new or problem you're trying to solve. I'm sure it has been tackled before in some way, shape, or form, either through nutrition and dietetics or with regard to other practice segments. Nursing has maybe done something similar or the other allied health professions.

So do your research and look and see what is out there. There are lots. Not only just the Academy's Journal of Nutrition and Dietetics but also on the Academy website. I made mention in prior sessions about visiting the Academy website as well as the commission on dietetic registration, and the CDR website. There are a lot of examples of quality improvement projects that have been done. There are some case studies under the CCR website under quality improvement, and then I previously mentioned the quickenars that the Quality Management Committee did.

So utilize what other people have done. I mean, how much more practical can that be than to look and see what other people have done? They identify what barriers they had to tackle, how they solved them, did they have successful outcomes. So I would say to look at what has already been done.

And then, the other practical insight is to collect data. You need to have data. If it can't be measured, it can't be improved. So be aware of the different types of quality measures that are out there. And this is another resource under quality management on the CDR website. There is a nutrition glossary of terms. And if I remember correctly when I was on the Quality Management Committee and the glossary of terms task force, there are four types of quality measures. You have structural measures, process measures, outcome measures, which are probably most important I would say, and then balancing measures. So in tackling an improvement initiative, as I said, if it can't be measured, it can't be improved, you have to have some sort of data to even know whether you have a problem or where you're at currently if you want to implement something new. So data collection is key to any quality or process improvement initiative.

Lisa Jones:

Yes. And there were several excellent takeaways I heard in that. The first one was to work smarter, not harder, and do your research. And if it can't be measured, it can't be improved. Excellent. So thank you for sharing all those.

Now, if we can move on and talk a little bit about how can we integrate technology and data analysis into our practice to streamline the clinical process and improve patient outcomes. And I guess, in addition to that, you can also infuse it... And you told us about so many great tools and resources already. So any other ones that you can think about in addition that go under that category so that patients receive the best possible care?

Sherri Jones:

Sure. One of the things that the Academy came up with as a data repository and great resource is something called ANDHII, A-N-D-H-I-I, I believe is the acronym, and that stands for the Academy of Nutrition and Dietetics Health Informatics Infrastructure.

Let's step back to 2003, 2004, whereabouts our dietetics profession and primarily clinical came up with our new practice model called the nutrition care process and the new way of doing assessment, diagnosis, intervention, and then monitoring and evaluating. And one of the things that came out of that was this whole set of standardized language. And the Academy partnered with several of the electronic health record companies and the clinical terminology databases, SNOMED is one example of those, to really get our nutrition terms integrated into the electronic health records.

Well, that was kind of step one. Step two is, how are we going to measure all that? We've been talking about measurement, and are we doing the nutrition care process? How often are patients diagnosed with a certain nutrition diagnosis? Do certain interventions help mitigate that diagnosis? What do we need to monitor and evaluate? So all of that needs to be tracked in some way. So the Academy developed this ANDHII system to help collect all of that information to then really, ideally, the output of all of that is more best practice guidelines and toolkits.

So I would say if you're not familiar with ANDHII, to look that up on the Academy website and consider utilizing that tool. The one thing that I need to point out, and I know when ANDHII came out, the unfortunate thing, and I know the Academy has known of this and is working to somehow overcome this, but the ANDHII system is separate, and my recollection and involvement had been that it doesn't directly interface with the other primary electronic health systems, whether it be Epic or Cerner. There are many others out there. So it is a separate step, but a very important step to collect that important data that we so need for our profession.

Lisa Jones:

Yes, that is so true. These resources are fantastic. So we will have a lot of resources listed in the show notes for everyone, all the listeners review. So I appreciate you sharing all this great information with us today, Sherri, and diving deeper into practical insights on clinical process improvement and nutrition strategies. Thank you for being our guest today. Thanks.

Sherri Jones:

Thanks for having me.

Speaker 1:

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