grass, fence, blue sky

“Coming together is a beginning; keeping together is progress; working together is success.” – Henry Ford

Through the Partnership to Advance Tribal Health (PATH), Great Plains Quality Innovation Network has had the privilege of partnering with 5 Indian Health Services (IHS) facilities in the Dakotas to improve the health of American Indian and Alaska Native people. The PATH project began in the Fall of 2016.

Specifically, PATH supports IHS hospitals to:

  • Develop leaders through training and networking
  • Build strong hospital systems through team-based care and clinical quality improvement
  • Strengthen patient, family and tribal engagement
  • Promote and spread best practices in hospitals
  • Ensure that clinical, operational and safety standards are met or exceeded
  • Assist with the development of hospital improvement plans
  • Establish baseline data to ensure plans for improvement are successful and sustainable

The Great Plains QIN team worked with the IHS staff to get a better understanding of their systems in place first-hand through onsite visits and conversations with IHS team members. In doing so, tailored support was offered as they collectively focused on building the capacity skills for leadership, staff development, patient safety and quality improvement competencies.

Natasha Green

In nearly four years of working together, the team has many reasons to celebrate. Natasha Green [pictured], Regional Project Lead,  commented, “the biggest contributors to success were the relationships and the trust established between the IHS facilities and Great Plains QIN team members. Once we established a sense of partnership, we made progress quickly.”

Green references the importance of understanding the tribal communities the hospitals work in. Teams worked to improve patient, family and tribal engagement; the results were used to strengthen the relationships between the hospitals and their communities. Input from patients, families and tribal communities was used in the quality improvement planning.

Staff development was a major part of the PATH project. Carin Greenhagen, RN; Chief Quality Management Officer in Rosebud, South Dakota, attended an Improvement Advisor Course provided by PATH. The year-long course was hosted by the Institute for Healthcare Improvement (IHI). Greenhagen stated, “It has been a life changing experience. The Model of Improvement and the tools we studied have impacted the ongoing quality process we currently use at Rosebud. Using data over time and developing teams early in the process proved to be the keys to change in our improvement program.  A Test of Change has become a common event and drives many of our process changes.  I believe I came home with the true understanding front line staff are the experts and need to be included in process change.”

“The PATH team has coached the Quentin N. Burdick Memorial Health Care Facility on several improvement initiatives. They offered assistance with updating our patient rights and responsibility policies and posters, initiating a yearly Culture of Safety Survey, developing an internal QAPI orientation manual and annual training guide and helping us improve our patient satisfaction survey. Honestly, the different projects they assisted us with are too numerous to list, but those are a few that stand out,” shared Crystal Allery MBA, BSN-RN; QAPI/Risk Manager of Quentin N. Burdick Memorial Health Care Facility in North Dakota. Allery added, “Natasha was an exceptional resource. She consistently provided guidance and support as needed.”

Green commented that one of the challenges was the lack of time. “There was always more to do with limited time to do it. The COVID-19 pandemic presented additional hurdles as technical assistance shifted to virtual and onsite visits were limited.” When asked what she was most proud of, Green responded, “The drastic change we saw from the beginning of the project and now. The teams and all involved exceeded all expectations set. It was really neat to be part of something so impactful. ”She concluded, “This was very important work. I feel fortunate to work with such a valuable and skilled team.”

Nikki Medalen

Nikki Medalen, MS, RN, [pictured] a member of PATH team, added, “What most impressed me with the PATH work was the ability of a work plan to be developed around the needs of the facilities. This plan was followed up with a very in-depth level of technical assistance due to the intensity of the project with just a handful of facilities. This is some of the most hands-on work that I have been part of within the quality improvement organization program. It’s truly amazing how far these facilities have come in a short period of time!”

A big shout out and appreciation to our Great Plains QIN PATH team members which include Nathan Brintnell, Katy Burket, Cheri Fast, Jonathan Gardner, Natasha Green, Denise Kolba, Nancy McDonald, Nikki Medalen, Vicki Palmreuter, Tasha Peltier and Geneal Roth. The team also wants to extend appreciation to previous team members which include Lori Hestad and Teresa Haatvedt.

The team also wants to acknowledge the important team members from the Great Plains IHS Facilities including Cheyenne River Eagle Butte, Pine Ridge Service Unit, Quentin N. Burdick Memorial Healthcare Facility, Rosebud Service Unit, Rapid City Service Unit and Standing Rock Service Unit.

The PATH initiative is funded by the Center for Standards and Quality at the Centers for Medicare & Medicaid Services (CMS). The current funding cycle ends in mid-July, but we are hopeful to continue this important work.