Working with PEACH
Functioning as a hub of resources, PEACH is designed to empower faculty and staff to take the lead on researching and improving equity-related issues. Faculty and staff who work with PEACH serve as Project Leads. Project Leads take the reins on the project; PEACH provides guidance, resources, and support tailored to the needs of the Project Lead to promote the project's success.
Given the diverse backgrounds and needs of our Project Leads, what support looks like can vary significantly. However, below we provide a general framework for how projects progress in phases at PEACH and the kinds of supports we provide as needed.
Proposing ideas to PEACH
All project ideas must be proposed through our intake form :
PEACH solicits project ideas from faculty and staff in our partnering units on a rolling basis through our intake form. Ideas are reviewed for their equity relevance and feasibility. Equity-related ideas are explored further in an initial consultation with a PEACH faculty mentor and the individual proposing the idea. In some cases, this may take several consultations as relevant stakeholders are identified and potential opportunities and barrriers assessed. With more information, the PEACH leadership team reviews the proposed idea.
To ensure fidelity to our mission and project success, we cannot advance all projects proposed. To better understand the kinds of projects we advance, please review our definitions.
Equity-related ideas that have the potential to be translated into feasible, impactful projects are accepted and move forward as a PEACH-supported project. We are also interested in the development of new and innovative methods and thus will advance projects testing the validity and feasibility of new methodological approaches to researching and addressing equity-related issues.
Investigating Potential Inequity
At PEACH, we move beyond observations and hypotheses to documenting whether inequities exist in practice. This requires data. Hence, all projects commence with research. Project Leads take ownership for this research, including the following general steps:
Design
Project Leads start by designing a research project. How the project is designed depends on the inequity of interest and available data sources, but all Project Leads will:
Define research question(s)
Choose the data source(s), methodological & analytic approach, and data management plan
Complete regulatory steps (e.g., Institutional Review Board application)
PEACH can support project leads in different ways throughout this process. Based on needs and preferences of the Project Lead, faculty mentors offer consultations on designing feasible, impactful projects. PEACH can also serve as a liaison to assist in engaging relevant stakeholders, including patients and their families. PEACH staff can help to identify relevant literature to inform the research and navigate regulatory steps. Our statistical and research team can advise on methodological and data choices. Quality Improvement specialists can also offer guidance on how to collect data in ways that can provide a foundation for effective quality improvement interventions if inequities are identified. PEACH also has a data hub where we can securely store project data, which can be helpful for designing a data management plan.
Implement
Once the project is designed and gains appropriate regulatory approvals, the Project Lead will implement the project including: collecting, managing, and analyzing data. These steps will vary across research projects depending on design.
PEACH will continue to offer ongoing mentorship and different kinds of support. Most notably, PEACH offers small and medium grants, which can be used for projects that require significant human resources, supplies, and/or participant incentives. Further, PEACH will organize collaborative events like work-in-progress sessions to bring together diverse experts to offer Project Leads the best advice on how to implement their research and overcome any barriers they face along the way.
Evaluate
Upon completion of the research, the Project Lead ultimately needs to answer whether an inequity exists and assess its extent. Importantly, our mission is not simply to find inequity. Because we lack sufficient research in this arena to date, we don’t know the degree to which inequity exists and where we already are providing equitable care to all patients and families. We also want to learn from the areas where we are doing well. However, if a Project Lead's research identifies an inequity, projects move to the Quality Improvement phase of their project: Improving Equity.
Note: Some Project Leads may choose to publicize their research findings at this point whether an inequity is identified or not. PEACH can support these efforts as desired by the Project Lead.
Improving Equity
PEACH's mission is to improve equity in the delivery of care to adolescents and children. To achieve this mission, Quality Improvement (QI) is fundamental to our work. If an inequity is identified through research, Project Leads then work with PEACH's QI staff to complete the following general steps:
Design
Project Leads start this phase by designing the QI project. The needs of each Project Lead at this juncture will vary depending on their backgrounds and what the project requires. With support as needed from PEACH, Project Leads will:
Engage stakeholders and conduct initial analyses of contributing factors to the inequity (if needed)
Set aims for the QI project
Establish measures to test and implement change
Design interventions to implement change
Complete regulatory steps (if needed)
During the QI phase of the project, Project Leads will receive ongoing mentorship from their Faculty Mentor, but will also be assigned a Quality Improvement Mentor who can help with all steps of the process, from design to implementation. This QI Mentor will coordinate with PEACH’s QI team to provide more comprehensive support for the QI project when needed. The QI team can provide guidance and support in the form of specialized knowledge and boots on the ground to work within a unit. The QI team and other PEACH staff and affiliates, including Advisory Board members, can also help coordinate with stakeholders in the unit to help promote the project’s success.
Implement
Once the project is designed and gains any necessary regulatory approvals, the Project Lead will implement the project including: implementing the intervention(s), collecting and assessing data, and adjusting interventions as needed.
PEACH can again offer small and medium grants, which can be used for projects that require significant human resources, supplies, and/or participant incentives. In some cases, for example, QI staff or PEACH research staff may be needed to implement interventions or analyze data. Project Leads may also choose to discuss the progress of their QI projects at PEACH collaborative events to gain input from diverse experts. And Project Leads will continue to receive mentorship from their Faculty Mentor and QI Mentor throughout the implementation process.
Evaluate
When it comes to QI, our goal at PEACH is to generate meaningful change that can be measured. If we are not generating change, we want to be aware of that and to adjust our strategy. All QI projects will be evaluated in an iterative, ongoing basis to measure change. Ultimately, Project Leads will be able to answer the question of whether they have effectively met their improvement goal.
Quality Improvement (QI) at PEACH
QI refers to a range of practices that have developed across time and industry to improve quality in products, processes, and systems. QI, for example, has been used to reduce manufacturing defects, improve transportation safety, and, in health care settings, improve patient outcomes and health care practices. So what exactly is QI? QI is defined in different ways by different industries and involves diverse techniques but generally united by a core set of concepts:
Measurable outcomes - QI efforts are oriented toward changing outcomes in ways that can be measured and evaluated.
Emphasis on process and systems - Under a QI framework, outcomes are the products of chains of events and complex, intertwined systems of people and information. Thus, effective QI efforts target processes and systems as opposed to individual behaviors.
Continuous improvement - QI efforts need to be ongoing because processes and systems are continually changing. QI interventions are implemented, data are collected and analyzed, and interventions are adjusted as needed in an iterative process.
Reducing variability - QI efforts reduce unnecessary variability in practices while preserving differences that matter. QI efforts focus on standardization when and where possible to systematically improve quality.
Here at PEACH, we use the latest quality improvement science to standardize processes and systems in ways that reduce variation in care and improve outcomes for patients and their families. Our PEACH QI team draw on their expertise to guide Project Leads in effectively addressing inequities identified, ensuring fidelity in the application of any technique, and, critically, identifying and engaging those who have the power and resources to instigate the changes required.
Documenting Impact
Project Leads conclude their project by documenting what they accomplished:
All Project Leads complete a PEACH Final Project Report, which documents what was accomplished during the project. As desired, PEACH can provide support to help Project Leads further:
Share findings through abstracts, publications, social media, and PR blasts
Use findings to apply for extramural grants and expand to new sites with the potential to make state- and national-level impact
Inform future quality improvement efforts through creating different resources (e.g., a package for change)
Our QI projects improve equity wherever inequity is identified here at Michigan Medicine. However, we don't want to stop there. We want to improve equity in the delivery of care to adolescents and children across the state and country. To achieve this aim, it is critical that we document our successes (and failures!) to help others learn and gain actionable insights to identify and address inequities.