AOTA member spotlight: Ana K. Brussa, OTR, OTD

Ana K. Brussa, OTR, OTD is the Director of Quality Assurance and Performance Improvement (QAPI) and Lead Occupational Therapist at Sonrisas Therapies- Pediatric Home and Healthcare Services. She spoke to Shannon White, COTA/L, MA, Program Manager for Practice Improvement and Advanced Certification at AOTA about her current position.

Shannon: Tell us more about your role as the Director of Quality Assurance and Performance Improvement.

Ana: As Director of Quality Assurance and Performance Improvement (QAPI), I oversee the completion of various chart audits and then analyze the data gathered from these audits to identify gaps in our procedures. I then share these findings with agency stakeholders at biannual QAPI meetings. As a team, we identify the gaps that will be our quality indicators for the next semester. After our quality focus areas are identified, I oversee the projects put in place to address them. This involves meeting with stakeholders, meeting with essential frontline staff, tracking the procedural changes being trialed, and analyzing the gathered data.

Shannon: How did you become interested in Quality?

Ana: The quality of the occupational therapy provided to the children and families I serve has always been important to my practice. Although advocating for open communication and better service processes for both my colleagues and patients has been a strength of mine, I struggled with turning that advocacy into action. When offered the opportunity to take on my current role, I saw the chance to learn how thoughts on procedural changes can be converted into measurable action and organizational-level change. I hope that through the improvement of our agency’s processes and procedures we not only promote a better patient-centered experience, but also improve the efficiency of our staff’s workflow.

Shannon: What are the top 3 skills that you use most, and how do you use them?

Ana: Communication, collaboration, and analysis. I feel that communication is so important, it should be considered a life skill. In this area, I draw from the Intentional Relationship Model. When meeting with others regarding processes that need improvement, I am mindful to provide judgment-free space so they can comfortably share their thoughts and feelings regarding procedures - what works well and what can be improved. When listening, I strive to do so from their perspective. Effective communication helps cultivate collaboration. Many times, in QAPI, I find myself working on improving a procedure in which I have little to no experience. It is essential to collaborate with team members who are on the frontlines of each step in the process. Then, there is analysis. When working to improve a process, the collection and analysis of data are crucial. Depending on the process, it may be possible to quickly determine if a change is working. If it is, great, we are on the right track. If not, then a new strategy may need to be implemented, and this would initiate a new stream of data and data analysis. However, without taking the time to collect and analyze changes to processes, we would lose valuable time in instituting effective change.

Shannon: How do you utilize quality measures in your current role?

Ana: Right now, the primary focus is examining how our agency’s procedures align with the dimensions of health care quality as defined by the Institute for Healthcare Improvement. These dimensions ask: is the care provided effective, safe, efficient, patient-centered, equitable, and timely? I use these dimensions when examining our agency’s capacity to provide quality service, the processes in place to do so, and our patient outcomes. In the future, I hope to broaden our scope to include Medicaid Quality Core Sets. As home health pediatric OT practitioners, we can be instrumental in the overall health and wellness of our patients and their families.

Shannon: What would you recommend as first steps to take if an OT practitioner is interested in learning more about quality or quality related roles?

Ana: Some excellent resources to explore are the Institute for Healthcare Improvement and the AOTA Quality webpage. Both provide access to free material for an interested practitioner to get started. I also encourage OT practitioners to run a small QAPI project at work. For example, there are never enough assessment protocols for patient evaluations, or supplies are consistently left around the clinic instead of being cleaned and put away. Collaborate with team members, set a goal, and trial solutions such as a weekly schedule for daily checks of assessment protocols or a checklist for practitioners using therapy supplies. See if the changes improve workflow. Sometimes, it is a small change in procedure that can have a big impact on our day. And don’t be afraid to fail - it is when we get it wrong that we continue to improve our process.