ECMO-/ECLS

medicine have demonstrated the importance of including a multi-disciplinary team with
members from all levels of the process including leaders and front-line staff [ 37 - 41 ].
Fundamental components of the QI process include developing mission and aim
statements that summarize the importance of the problem being addressed and the
value or goal of the initiative [ 36 ]. In particular, the aim statement should identify the
intervention targeted with expected levels of change within a specified timeframe. The
aim is developed by “mapping” out the process using tools like key driver diagrams,
conceptual flow models, or cause and effect diagrams to identify leverage points that
represent the best opportunities for improvements. The team will subsequently develop
interventions that can affect one or several of the key drivers and lead to successful
change to achieve the aim. Interventions to be tested should be specifically defined
including how to measure compliance and what outcome to measure to determine
success. In critical care, the intervention may be developing a “best practice protocol”
using the available literature, guidelines, local and national expert opinions and the
experience of the QI team members to come to a consensus protocol that can be
implemented in their ICU. Importantly, the QI team should recognize that compliance
with an intervention is more likely if it is easily implemented and can be incorporated
into everyday workflow. The integral relationships between developing an aim,
identifying key drivers, and developing feasible interventions have been well
documented in previous QI initiatives [ 36 , 38 , 41 ].
Other key components for a successful QI initiative are measuring and providing
feedback on compliance and understanding reasons for non-compliance [ 36 ]. Providing
feedback to the involved staff will raise awareness about the intervention and lead to