ReImagine: Amulti-Disciplinary Quality Improvement Plan to Work at Top of Scope

There is a growing need for quality, community care models centered on the care of the child with medical complexity. This quality improvement project was conducted in a community-based medical daycare program within a large, metropolitan, pediatric hospital network of care location. A multi-disciplinary team, led by a clinical nurse specialist, occupational therapist, and early childhood special education teacher, addressed staff frustrations and low morale related to barriers to working at top of scope and feelings of a chaotic care and learning environment for children.

To improve staff satisfaction through a decrease in perceived barriers to practicing at top of scope and to refocus each discipline's role. A secondary aim was to improve child engagement through restructuring the therapeutic and learning environment and reducing distractions to better meet the unique needs of the children the program serves.

This quality improvement (QI) project used multiple methods, including staff surveys, child observations and timecard review, to measure the project's impact on ability to work at top scope, child engagement and staff satisfaction.

The QI project resulted in positively impacting work culture and structure by increased time professional staff practiced at the top of scope, decreased perceived barriers to do so, improved overall job satisfaction and improved child engagement.

Increased multidisciplinary collaboration and increased structure promoted an enhanced learning environment, healthier staff environment, and a more fiscally responsible program. There is little knowledge about medical daycares and further investigations in this setting is warranted.