With his passion for quality improvement, David B. Larson, MD, MBA, FACR, who serves as chair of the ACR Commission on Quality and Safety, shares the origins of the ACR Learning Network, its purpose and what participants can expect from the program.
Larson is a professor of radiology at Stanford University, where he also serves as the senior vice chair for education and clinical operations in the radiology department. He is the associate chief quality officer for improvement for Stanford Health Care and physician co-leader of the Stanford Medicine Center for Improvement. He is also the founder of the Realizing Improvement through Team Empowerment (RITE) program, co-founder of the Clinical Effectiveness Leadership Training program and founder of the Advanced Course for Improvement Science, all at Stanford.
What is the ACR Learning Network?
It’s a program that is designed to help local teams make improvements in specific patient care areas by growing skill sets in problem-solving and enabling sharing of ideas between organizations.
The ACR Learning Network is made up of separate improvement collaboratives, each of which uses this same general approach to address different challenges. We have started with four improvement collaboratives: lung cancer screening, mammography positioning, prostate MR image quality and recommendations follow-up. Any radiology practice, hospital or imaging center can apply to enroll a team in any of the four areas through participation in the Learning Network.
What kind of time commitment is required?
On average, team members spend a few hours a week during the four-and-a-half-month improvement program, though it varies by participant role.
How is the time broken up? Is it protected time?
When an organization signs up, the leaders commit to organize and protect the time for a team of four to six people to work on one of the collaboratives’ topics. Team members participate in the 10 two-hour improvement training sessions held every two weeks. We also hold a review session every other week where project leaders present an update and receive guidance. Then there’s the time they spend working on the project, which is where we want the teams to put most of their focus. This generally takes a couple of additional hours each week.
Can an institution solve these kinds of challenges on its own?
In theory, any organization could make these types of improvements without help from a program like the Learning Network, but in reality, we find that that rarely happens for a variety of reasons. These types of improvement initiatives are much more likely to be successful in a structured program like this one.
Whose idea was the ACR Learning Network?
The idea of the ACR Learning Network was an outgrowth of my work in developing a number of improvement training and project-support programs at Stanford, which were built on my experience at Cincinnati Children’s Hospital. The quality improvement (QI) training portion of the Learning Network, ImPower, was patterned after the RITE program at Stanford, which was initially supported by an RSNA Research and Education grant. I was fortunate to be able to hire Kandice Garcia Tomkins, MS, RN, who now serves as the QI director for the Learning Network. We now have eight years of experience at Stanford, with 40 cohorts of more than 2,000 graduates completing around 250 team-based projects.
As I came into my role as the chair of the ACR Commission on Quality and Safety, I was fortunate to have an incredible partnership with ACR Executive Vice President Mythreyi B. Chatfield, PhD, generous support from ACR executive leadership and amazing contributions from the talented and dedicated ACR Q&S staff. We worked together to submit a proposal to the Gordon and Betty Moore Foundation, which generously provided funding support for the program. So while I contributed the idea and the vision, this program has quickly become a labor of love for many passionate people who have made it a success.
The ACR Learning Network is made up of separate improvement collaboratives, each of which uses this same general approach to address different challenges.
Did the pandemic influence this project, given the timing of its beginnings?
In retrospect, it turned out the changes that came about from the pandemic probably contributed to the success of the program in that the pandemic enabled virtual meetings to be widely adopted as an acceptable and productive way of conducting business across long distances. For example, our training programs we have here at Stanford had all been in person up until that point; along with everything else, we converted the in-person sessions to virtual meetings. We were also sponsoring similar training programs at other institutions as a trial, and we converted those into virtual formats. We’ve just recently published our experience with that and found it actually worked really well. That gave us the confidence that this could succeed in a virtual environment at scale.
Why did you choose the topics you chose for the four improvement collaboratives?
The best candidate topic for an improvement collaborative is one that has an outcome which is difficult but possible to achieve through effective coordination of processes, systems and people. It also needs to be important to a variety of stakeholders and have at least a strong theoretical link to patient outcomes. The topic should be amenable to measuring performance, though there does not necessarily need to already be a fully developed measure in place. Each of the four topics we ended up selecting meets these criteria.
Will other improvement collaboratives be added?
One of our long-term goals is to expand the scope of the program. In fact, that’s why we launched four collaboratives in the beginning. The Gordon and Betty Moore Foundation was cautious about starting with that many collaboratives right out of the gate, but we felt it was very much in the spirit of what we were trying to accomplish with the Learning Network. In other words, just as each site should learn from each other within their respective improvement collaboratives, each improvement collaborative should also be learning from each other within the overall Learning Network.
Over time, we hope the program can be streamlined and expanded in a predictable way. For example, we will soon be able to give a reasonable estimate of both the costs and likely benefits of standing up another improvement collaborative within the Learning Network — then it becomes a relatively straightforward cost-benefit assessment.
Why should a program participate?
We recognize that joining the Learning Network requires a real investment. But we are confident it is just that — not a cost, but rather a worthwhile investment into the individuals in your organization and the organization as a whole. It’s the kind of investment that turns on its head the conventional wisdom that greater costs more. Once the investment is made, we are convinced it easily pays for itself in financial and other ways. For example, we find that when participating sites develop a program for organizational development, such as a coaching model to support their frontline staff, those staff members feel supported and tend to stay at their organization. This becomes a powerful recruiting and retention tool that positions your organization favorably and also decreases problems associated with high turnover. In other words, it requires a bit of a leap of faith to get started. But once they do it, we’ve found that participants consistently say, “Yes, it was a lot of work. Yes, it was humbling. And yes, it was hard. Would I do it again? Absolutely.”
This is a big project. How and why do you do it and still have a full-time job (or two)?
I think my motives are the same as anyone else who volunteers for the ACR and other radiology societies — for the love of the profession we have inherited and the desire to meaningfully contribute by helping to make it better.
I don’t think we should underestimate our ability in radiology to impact the entire medical field for the better. In fact, the Gordon and Betty Moore Foundation has told us they view this as a showcase model for learning networks in general. If we do it right, our efforts can not only improve radiological care but can also improve healthcare more broadly. And this is just one of many examples of how radiology leads the field in important ways.
With that type of opportunity, you make time — especially given the wonderful staff and colleagues we have throughout the ACR. The opportunity to work with such amazing people to create something that can be self-sustaining for decades to come is incredibly rewarding. Come join us and we’ll build it together — and have a lot of fun on the way.