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Small changes, big outcomes: Quality improvement in health care

Knowing even small changes in health care can have a big impact on someone’s life inspires Pamela Mathura. It fuels her passion for quality improvement and it is what led her to pursue a degree in health quality, becoming one first students to enroll in Queen’s health quality doctoral program. Now Mathura, a quality improvement and implementation scientist at Alberta Health Services, is set to walk the convocation stage this spring as Queen’s University’s very first PhD in health quality graduate.

Quality improvement, often referred to simply as ‘QI’, is a formal analysis approach that broadly focuses on enhancing performance and experiences. QI outcomes in health care can look like shortened hospital wait times, faster diagnostic tests, or reducing the risk of clinical errors. Mathura’s own work in health care QI led her to become involved in supporting living kidney donors in Edmonton, seeking to identify and remove unnecessary systemic barriers in their donor journeys.

headshot of Pamela Mathura

The problem? Previously, it could take over a year in Edmonton to complete all the necessary diagnostic tests if you wanted to donate a kidney. Long wait times can become a serious barrier to adequate care, for both prospective donors and the people waiting to receive life-saving transplant surgeries. With this issue in mind, Mathura began mapping all the steps required for kidney donor screening and testing. From there, she partnered with physicians and radiology lab technicians at the University of Alberta Hospital, seeking their input on how to safely shorten the donor testing process.

“Long story short, we went from 365 days to two,” says Mathura. “What started as a $12,000 QI project with five patients, is now a $1-million project with a team of researchers behind it.”

Mathura’s PhD research focuses on physician-led QI strategies, a relatively new concept. For her, physician involvement in implementing quality improvement health care practices is critical to lasting, systemic improvements. She recently published a scoping review examining several ‘enabler strategies’ to increase physician-led QI initiatives. These strategies range from having more dedicated support staff to increasing physician mentorship opportunities. The review also examines the importance of collaboration in the adoption of physician-led QI projects.

“We are seeing a growing need [in healthcare] to use resources more mindfully,” says Mathura. “It’s so important that within a health region or province or country, we figure out how to collaborate.”

She also credits Queen's faculty and her thesis supervisor Jennifer Medves with helping her achieve success in the doctoral program. With their encouragement, she successfully applied for a $50,000 external research grant from Choosing Wisely, an American Board of Internal Medicine initiative. The funding helped support her thesis: “Factors of a Physician Quality Improvement Leadership Coalition That Influence Physician Behaviour.”

Mathura highlights "sharing quality improvement to encourage quality improvement" as the key takeaway of her thesis research and her time in the Health Quality Program. She emphasizes that in addition to collaboration, community is key to successful QI outcomes. “People need to see themselves in a community,” she explains. “See what they can bring to it and see what they can learn from it.”

Health Quality Programs’ Associate Director Dr. Rosemary Wilson is excited to attend Mathura’s convocation and welcome her to the Queen’s alumni community. “Congratulations to Pamela on being the first to complete our doctoral program. We look forward to learning about her continued research and contributions to Health Quality," says Dr. Wilson.

After graduating this spring, Mathura plans to continue her research and share QI strategies in health settings across Canada, building a practice community for physicians working to implement quality improvement in their workplaces.

“What gets me up every day is remembering that quality improvement is about people, for people, and with people, and that the outcomes of something very small can have profound effects on someone's life.”