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20-11-2023 | Original Research

Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days

Authors: Amelia Sattler, MD, Anuradha Phadke, MD, Jake Mickelsen, MBA, Timothy Seay-Morrison, EdD, LCSW, Heather Filipowicz, MS, RD, Davis Chhoa, BA, Malathi Srinivasan, MD

Published in: Journal of General Internal Medicine

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Health system change requires quality improvement (QI) infrastructure that supports frontline staff implementing sustainable innovations. We created an 8-week rapid-cycle QI training program, Stanford Primary Care-Project Engagement Platform (PC-PEP), open to patient-facing primary care clinicians and staff.


Examine the feasibility and outcomes of a scalable QI program for busy practicing providers and staff in an academic medical center.


Program evaluation.


A total of 172 PCPH team members: providers (n = 55), staff (n = 99), and medical learners (n = 18) in the Stanford Division of Primary Care and Population Health (PCPH) clinics, 2018–2021.

Main Measures

We categorized projects by the Institute for Healthcare Improvement’s (IHI) Quintuple Aim (QA): better health, better patient experience, lower cost of care, better care team experience, and improved equity/inclusion. We assessed project progress with a modified version of The Ottawa Hospital Innovation Framework: step 1 (identified root causes), step 2 (designed/tested interventions), step 3 (assessed project outcome), step 4 (met project goal with target group), step 5A (intervention(s) spread within clinic), step 5B (intervention(s) spread to different setting). Participants rated post-participation QI self-efficacy.

Key Results

Within 1000 days, 172 unique participants completed 104 PC-PEP projects. Most projects aimed to improve patient health (55%) or care team experience (23%). Among projects, 9% reached step 1, 8% step 2, 16% step 3, 26% step 4, 21% step 5A, and 20% step 5B. Learner involvement increased likelihood of scholarly products (47% vs 10%). Forty-six of 47 (98%) survey respondents reported improved QI self-efficacy. Medical assistants, more so than physicians, reported feeling acknowledged by the health system for their QI efforts (100% vs 61%).


With appropriate QI infrastructure, scalable QI training models like Stanford PC-PEP can empower frontline workers to create meaningful changes across the IHI QA.
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Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days
Amelia Sattler, MD
Anuradha Phadke, MD
Jake Mickelsen, MBA
Timothy Seay-Morrison, EdD, LCSW
Heather Filipowicz, MS, RD
Davis Chhoa, BA
Malathi Srinivasan, MD
Publication date
Springer International Publishing
Published in
Journal of General Internal Medicine
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497