QI Team and Specific Measurable Achievable Relevant and Timely
(SMART) Aim
After reviewing the data from our retrospective study revealing high
prevalence of Vitamin D deficiency and insufficiency, we assembled an
inter-professional QI team.
Our QI team followed the Institute for Healthcare Improvement’s Model
for Improvement14 and the QI leader completed formal
QI training. The QI leader was a pediatric Hematology/Oncology physician
who worked closely with the team that included physician champions,
nursing staff, QI advisors, and content experts from pediatric
hematology/oncology, hospital medicine, pediatric endocrinology and
information technology (IT).
In person QI team meetings were held biweekly beginning with the
planning phase and throughout the project to address interventions,
discuss unexpected observations and problems encountered, review study
data and decide on interventions to be implemented.
The entire team participated in development of the Key Driver and
Ishikawa diagrams (Figures 1 & 2), the SMART Aim, the decision-making
tree (Figure 3) and reviewed the Plan-Do-Study-Act (PDSA) cycles. Input
from other key stakeholders (physicians, advance practice providers,
oncology case managers, pharmacists, inpatient and outpatient nurses)
was obtained about potential barriers and facilitators to Vitamin D
testing at the time of initial cancer diagnosis and proposed
supplementation strategies. The QI team leader contributed approximately
six hours of time each week during the first four months of the project
and then approximately four hours per week during subsequent months.
Our SMART Aim was: From February 1 to June 30, 2016, compliance with
institutional guidelines for Vitamin D testing and supplementation in
children with newly-diagnosed cancer (aged 2-18 years old) will be ≥80%
from a baseline of 0% and sustained over subsequent months.