Two Minds Blog

One of my teaching roles involves reviewing clinical quality improvement (QI) projects led by students in our Doctor of Nursing Practice (DNP) program. The classic QI method involves looking at regular reports from a clinic or hospital unit, graphing the data either monthly or weekly, and making changes with the hope of seeing a sharp improvement on the graph right around the time that the interventions were put into place. For example, a student might measure the percentage of hospitalized patients who have a fall after surgery (generally considered to be a preventable adverse event) on a weekly basis. If the rate is generally stable, but it goes down after the student initiates some provider training and a new procedure to screen patients for fall risk, and then the rate stabilizes at the new lower level going forward, it’s reasonable to assume that the student’s QI project caused the improvement. Regular measurement is the key: In the words of management consultant Peter Drucker (i

In a study last year , colleagues and I found that people with HIV experienced high levels of fatigue and that their fatigue was predicted by everyday factors like sleep, stress, and mood. These findings showed interesting differences between people’s conscious (Narrative mind) experiences of fatigue and the daily non-conscious factors (Intuitive mind) that actually predicted their day-to-day levels of fatigue.  Knowing this, I wondered whether we could help people to reduce their fatigue by giving them more information about predictors of fatigue that are normally outside of their awareness. I was able to conduct a preliminary test of this idea (pre-COVID) in a single case study where I met with an additional participant who would have qualified for the study, but who enrolled after the main data collection phase was completed and analyses had already begun. This serendipitous timing allowed me to provide the participant with information compiled from all of the other people in the st