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Our quality improvement efforts give our clinically focused doctors a chance to publish in academic journals.


Seattle Children’s has taken a page from the Toyota Production System’s playbook and embraced an institution-wide program to improve safety and the quality of care and service we provide to patients and families. Known as Continuous Performance Improvement (CPI), this data-grounded approach inspires investigation and a cycle of ongoing, incremental improvements.

A hallmark of this approach is that the people involved in the work analyze the issues and inefficiencies and determine the best ways to solve them. CPI’s well-established guidelines help these participants step back from an immediate problem and figure out its root cause.

Data that matters

At Children’s, clinically focused physicians are heavily involved in many CPI projects because their daily experience caring for patients gives them unique insight into how to improve care and service. Normally, their full-time clinical duties provide these physicians little opportunity for research compared to their peers who also focus on research or education. However, through their involvement in CPI, they are generating data and results about improved safety and outcomes that are worth publishing — adding an academic dimension to their careers without detracting from their clinical roles.

“Several clinical faculty members have already published papers or presented at conferences, and the number will continue to grow as we continue to use CPI to improve the quality and efficiency of our care,” says Dr. Bruder Stapleton, Children’s chief academic officer and chair of University of Washington School of Medicine’s Department of Pediatrics.

Seattle Children’s is an academic institution and most physicians are also members of the faculty at the University of Washington. Although only physician-scientists and physician-educators must publish as part of their jobs, it’s also important for clinically focused physicians to publish and/or present at conferences.

Potential to improve care

“When you create better outcomes for patients, you have a responsibility to spread the word. And you spread the word by publishing.” – Hospitalist Dr. Darren Migita

“It can help advance their careers and foster peer recognition, but it also makes their work more satisfying because of the potential this work has to improve care for patients and families,” says Stapleton.

Dr. Darren Migita, a pediatric hospitalist, was the lead author of a paper published last year in Pediatrics, the journal of the American Academy of Pediatrics, that describes how Children’s used CPI to standardize the placement of peripherally inserted central catheters (PICCs) in patients.

“Because I’m so busy caring for patients, I don’t have a lot of time for research, but my work with CPI enabled me to combine the two,” Migita says.

Sharing the results

Children’s is the first pediatric hospital in the country to apply CPI to the delivery of patient care, which makes the publication efforts of clinical faculty like Migita significant beyond the effect on their careers.

“We need to be publishing everything we’re doing with CPI so that it can be shared with other healthcare providers,” says Dr. Mark Del Beccaro, Children’s pediatrician-in-chief. “We’re the leader in this, and people are very interested in seeing how CPI works and the results it produces.”

For example, CPI helped Children’s reduce PICC use by 37%, which is important because PICCs are often overused and they increase the risk of infections and other complications. The CPI work also reduced delays in placing PICCs that were necessary.

“When you create better outcomes for patients, you have a responsibility to spread the word,” Migita says. “And you spread the word by publishing.”

CPI helped Children’s reduce PICC use by 37%.