ECMO-/ECLS

into identifying a high priority disease or treatment as the “process” to improve and then
applying a series of principles to understand it, identifying areas that can be improved,
implementing steps to reduce variation, and ultimately measuring outcomes to
document improvement.
One key principle for a successful of QI initiative is leadership [ 36 ]. This entails
having support from the administration or supervisors for the project and identifying a
project champion who functions as the team leader. QI initiatives are more likely to be
successful if there is institutional leadership support and involvement in the process.
The most successful environments for QI are those in which there is an institutional
culture that is open to identifying areas for improvements and accepting of changes to
existing processes In addition, successful QI requires the development of a team that
includes members involved in all levels of the process including the frontline
practitioners. Depending on the process involved, this may include physicians, nurses,
respiratory therapists, nutritionists, environmental staff or others. This “bottom up”
approach allows the involvement of personnel most intimately involved with the process
who can offer unique insights into the process and potential areas for improvement. It
also develops a sense of shared ownership or responsibility across all members of the
team at all levels of care which will increase the likelihood of adoption of the intervention
and the sustainability of successful changes; members of the QI team become
champions for the initiative to their respective peer groups and to the multi-disciplinary
team. Previous successful studies of QI initiatives to improve hand hygiene and reduce
rates of ventilator-associated pneumonia (VAP), central line-associated bloodstream
infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) in pediatric