CQII - How to Develop a Case Study (2).docx

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2024 CQII Quality Fellows Program
Case Study Development Guide

This guide explains how to write a descriptive case study. A descriptive case study describes how an organization handled a specific issue or change
idea, and in this case, we will focus on a quality improvement (QI) project or concept you and/or your organization has had experience with. Case
studies can vary in length and details provided. We would like your case studies to be based on events that happened within your organization.
Why are you being asked to write one?
The Fellowship is using a collaborative approach to learning, and case studies can help organizations and Fellows learn from one another about:
• new QI concepts,
• how to best document processes,
• best practices during any stage of a QI project,
• lessons learned and issues to avoid during any stage of a QI project, and
• similar scenarios they may face within their quality management programs.

Writing a case study also helps teams critically examine their organizational practices – which ideas did they adopt, adapt, or abandon, and why?
Documenting processes gets improvements to “stick,” ie spread, across your organization.
Case studies can also inform the development of more robust theory that identifies the links between problem, intervention and outcome, and we
hope that fellows’ real-world examples can contribute to CQII’s larger effort to generate generalizable knowledge that can be more widely and
systematically applied by HIV practitioners nationwide.
In what context will these be used?
 CQII: CQII envisions using these as examples for those beginning and continuing their QI journeys in our learning spaces – primarily during
learning collaboratives, Learning Lab, Quality Academy and in our in-person trainings. CQII also sees this as an opportunity to share the
expertise of sites during presentations and other learning events we facilitate.
 Within Organizations: Case studies are great learning tools within organizations as well, and we hope you can apply them in a number of
spaces: as examples for your QM team to learn from; to onboard new team members with examples and experiences specific to your
program; to spread well-documented, innovative ideas; and as learning tools from which to deduce applied QI concepts.
 For publication: Case studies that are methodically and rigorously reported are increasingly being published in journals to spread innovative
ideas. As a long-term goal of the fellowship, we hope to support this kind of work. See: How to Write Up Your Quality Improvement
Initiatives for Publication - PMC (nih.gov)

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Writing Tips
 How should I break up the writing? When is this due?
o We would like to divide the writing into parts:
 Steps #1-3: due May 27
 Steps #4-5: due June 26
 What kind of QI projects should we write about? Your areas of expertise! We (CQII) are also always seeking examples of:
o Consumer involvement in quality management/quality initiatives
o Cross RWHAP part alignment in QI
o Sites building QI capacity – a site training or coaching others; conducting in-person, virtual training(s) or sessions; innovative ways that
sites have implemented these trainings
o Experience with applying CQM or CQII guidance, tools, resources to site activities
o Summary of experience using a QI tool and its application (at the beginner, intermediate and/or expert levels)
o Sustainability examples – how did you all plan to sustain those improvement efforts that you have standardized?
o Impact of participation in CQII activities (learning collaboratives, in-person trainings, Learning Lab, Quality Academy)
 Use plain/simple language.
o Use the same term consistently to refer to specific concepts or ideas:
 If you refer to a program as “The Patient Evaluation of Performance Project (PEPP)” in the beginning of your case study, do not
later refer to it as “the performance initiative.”
o Minimize/spell out abbreviations (if using special terminology, define it for readers)
o Use short, simple words
o Consider using bulleted lists, images, tables/graphs or illustrations to make complex material (ie data, staffing charts, etc) easier to
understand
 Use active voice.
o Write in active voice, not passive voice. Keep the subject and verb close together:
 Passive: About 200 patients were left with incorrect, high medical bills as a results of staff errors while using the hospital’s new EMR.
 Active: Staff errors while using the hospital’s new EMR left 200 patients with incorrect, high medical bills.
 Which narrative perspective will you use?
o A first-person perspective uses words such as “I” and” “we” to tell a story. A third-person perspective uses pronouns and names such as
“they” or “CQII”. Be consistent throughout your case study.

 Who will proofread and give feedback?
o After each deadline below, the case study will be shared with coaches, CQII staff and other fellows for review and feedback. They will
highlight any words or sentences they find confusing. They will also write down one or two questions that they still have after reading the
draft. You can then use these notes make edits. CQII staff will communicate this process in May.

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Case Study Template

Fellow Name(s): First name, last name
Coach: First name, last name
Date: Month/Day/Year
Step 1: Identify and write for an audience

Which of the audiences below am I writing my case study for? What does my audience already know about the subject? (Check all
that apply)
☐CQII learning platforms: We anticipate beginners (little to no experience with QI) to advanced users (those who have applied
many QI tools and methods with complexity and have taught others) reading and using these case studies from which to deduce
QI concepts and tools. You can assume they are RWHAP recipients or subrecipients familiar with Ryan White programming.

☐Members of your organization: If your audience includes those who may not take part in HIV care directly, consider this when
deciding how much or how little detail to provide about a concept, program, etc.

What is the background of my audience? (Check all that apply)
☐RWHAP recipients
☐RWHAP subrecipients
☐Members of your organization
☐Other: Please provide any other context here, such as if you are writing for other EMAs/TGAs, core medical or support services
programs, etc

What is my audience’s QI Proficiency level?
☐Beginner (little to no experience with or knowledge in QI concepts)
☐Intermediate (have applied many QI tools and want to use them with increasing complexity)
☐Advanced (have applied many QI tools including frameworks outside the Model for Improvement, and have taught QI to
others)
What are the goals of reading my case study? After reading my case study, readers should: e.g. understand how to utilize a run chart to
understand variation; understand my EMA’s approach to spreading innovation, and how we diffused a new change idea beyond an initial
test site for subrecipients to adopt

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Step 2: Provide Organization Details

Case Study Title: Click or tap here to enter text.

Organization’s RWHAP Project Funding (check all that apply):

☐Part A ☐Part F - The Special Projects of National Significance (SPNS)
Program
☐Part B ☐Part F – AIDS Education and Training Centers (AETC)

☐Part C ☐Part F – Dental Programs

☐Part D ☐Subrecipient (I am a subrecipient of a Part A, B, or D recipient)

Location: City, State

Size of agency: e.g. “15 staff; 500 staff etc

Organizational Chart
If possible, please include a simple illustration of an organizational chart describing how QI stakeholders interact to collaborate on solutioning this
problem. Understanding your organization’s structure will help readers understand activity between team members and reporting links to leadership,
etc. Below is an example (please delete figure below and include your own):

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Step 3: Project Introduction & Context

Up to ~200 word summary of:
 The history of the QM staff/team and organization leadership,
 the problem and aim and/objectives of the QI project,
 demographics or relevant characteristics of the community you serve,
 any brief data points relevant to the project and time point (VLS, relevant quantitative/qualitative findings, etc)
Click here to type your summary

1. Initial Problem Statement: Example: Despite effective and readily available, simple regimens of HCV treatment known as direct-
acting antiviral (DAAs) at our clinic, only 50% of HIV/HCV co-infected patients whom are also recommended for treatment have achieved
sustained virologic response (SVR)/cure.
a. Subsequent Problem Statement(s): If you had to adapt this statement over time, include that here.

2. Aim(s): What was your initial aim statement? Did this change over time? (If so, please include all aim statements below)
a. Aim 2 Date/revised aim
b. Aim 3 Date/revised aim
3. Goal: e.g. To improve rates of HCV cure in eligible patients with HIV/HCV coinfection
4. What tools did you use to support choosing interventions?

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5. Drivers & Measures – please list each driver you were addressing on the left, its applicable process measure in the middle,
and the goal you hoped to achieve on the right.

Driver Process Measure Goal & Outcome Measure
e.g. 1. patient education and awareness % of patients eligible for HCV treatment
who receive counseling and education
materials about DAAs
90% of patients eligible for HCV treatment
will have documented used of educational
materials before leaving appointment by
January 2025
2.
3.
4.

6. Data Summaries (you can also include this information below the tables in “Step 4: PDSA Summaries”):

a. Pre-implementation/baseline data collected:

b. Post-implementation data collected:

7. Conclusions, Spread & Sustainability
a) Outcomes: What were the outcomes? What were notable achievements? Did you achieve your aims? If you didn’t, did you
make other improvements, and what were they?
Examples: Increase in number of attended visits from 40% to 75%; Decreased average time from genotype testing (which
determines treatment) and treatment initiation from 5 weeks to 2 weeks; Increase in number of co-infected patients achieving
cure from 50% to 70%; increase in patients utilizing HCV education materials from 40% to 80%

b) Conclusions: Summarize lessons learned. What can your readers learn from your PDSA? What worked well? What would you do
differently?
c) Standardization: If you adopted the change, how did you make the proven change ideas the new status quo? Share who
carried out each task to standardize the change below. How did you standardize them in your organization?


Task Person Responsible

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Step 4: Framing Questions

1. What question were you trying to answer? e.g. “Why is effective HCV treatment (DAAs) not being more widely utilized by eligible patients
living with HIV/HCV coinfection who could be cured of HCV?”

2. What was the test of change? E.g. “Rather than scheduling a follow-up visit with a specialist off-site to have their HCV treated, the clinic will
coordinate warm hand offs to an on-site HCV specialists for 3 patients with HCV who are eligible for treatment, and whom all have
appointments between May 1-15.”

3. What was your hypothesis/prediction about what will happen when you implemented the change? e.g. if we lowered no-show rates to
off-site follow-up appointments with our HCV specialist, then our rates of HCV cure (also known as sustained virologic suppression or SVR) will
increase.

4. How did you know that the change would be an improvement? After May 15, the following data will we reviewed by the QI team: # of visits
attended; # of genotype tests ordered; # of patients who initiated treatment. If appointments, testing and visits are kept, the team will assess
adherence/sustained virologic response after 12 weeks (a standard course of treatment). If there is treatment failure, the team will try a new test.

5. What ideas did you brainstorm that could result in an improvement? List a few here. (If you have these included in a driver diagram,
please indicate that here and skip this question) Systematically using patient education materials during visits with patients eligible
for treatment; warm handoffs (rather than offsite appointments) to HCV specialist; train all MDs, NPs and PAs in HIV/HCV
coinfection treatment so all are comfortable managing treatment




Step 5: PDSA Cycle Summaries

Documentation of each test

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How did you leave an audit trail for this project, and a teaching aid for other projects? Please describe each test of change cycle in the
chart below. Other visuals that help your audience understand your project (charts, completed tools, etc) are welcome to be copy and
pasted below each table describing the applicable cycle.
*If you have this recorded in another format, feel free to copy and paste it here, rather than adapting into the table below.

Cycle # Click to enter #
Approximate Date: Month/Day/Year
Aim Statement: Re-state this for each cycle – did it change over time?
Stage Action Item
(ie what tools or methods did you use?)
Staff Responsible
(ie QI implementation lead;
resident; case managers
etc)
Time Point
(ie day or week
1, etc)
Data/Measures
(# missed
appointments,
knowledge gained, etc)
Plan e.g. Process Mapping
e.g. 5 Whys (Root Cause Analysis)
e.g. Data Collection
What change ideas were brainstormed to address identified issues?
Do What did you observe, including any problems and unexpected findings?
What data did you collect that you identified as needed during the “plan” stage?

Study
(How did
you study
and
analyze the
data?)

Did the results match your predictions? Yes ☐No☐

Were there implementation lessons? Summarize what was learned, like
unintended consequences, surprises, successes, failures.

Were there implementation lessons? Summarize what was learned, like
unintended consequences, surprises, successes, failures.

Act*
(Did you
adapt,
adopt or
abandon?)

Choose one: adapted, adopted, abandoned
Describe what modifications to the plan were made for the next cycle from what
you learned.

If you chose to adopt, how did you expand your test?
If you chose to adapt or abandon, what did you brainstorm to modify your
approach and repeat the cycle?

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*Based on what was learned from the test:
Adapt – modify the changes and repeat PDSA cycle; Adopt – consider expanding the changes in your organization to additional residents, staff, and
units; Abandon – change your approach and repeat PDSA cycle.

1. What tools did you use to support this cycle? Please include the tool and results below.
1a. Please include any visuals of your completed tools: please delete the example figures below and include your own






Cycle # Click to enter #
Approximate Date: Month/Day/Year
Aim Statement: Re-state this for each cycle – did it change over time?

Example: Fishbone diagram

Example: Flow chart

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Stage Action Item
(ie what tools or methods did you use?)
Staff Responsible
(ie QI implementation lead;
resident; case managers
etc)
Time Point
(ie day or week
1, etc)
Data/Metrics
(# missed
appointments,
knowledge gained, etc)
Plan e.g. Process Mapping
e.g. 5 Whys (Root Cause Analysis)
e.g. Data Collection
What change ideas were brainstormed to address identified issues?
Do What did you observe, including any problems and unexpected findings?
What data did you collect that you identified as needed during the “plan” stage?

Study
(How did
you study
and
analyze the
data?)

Did the results match your predictions? Yes ☐No☐

Were there implementation lessons? Summarize what was learned, like unintended
consequences, surprises, successes, failures.

Were there implementation lessons? Summarize what was learned, like unintended
consequences, surprises, successes, failures.

Act*
(Did you
adapt,
adopt or
abandon?)

Choose one: adapted, adopted, abandoned
Describe what modifications to the plan were made for the next cycle from what you
learned.

If you chose to adopt, how did you expand your test?
If you chose to adapt or abandon, what did you brainstorm to modify your approach
and repeat the cycle?

*Based on what was learned from the test:
Adapt – modify the changes and repeat PDSA cycle; Adopt – consider expanding the changes in your organization to additional residents, staff, and units;
Abandon – change your approach and repeat PDSA cycle.

1. What tools did you use to support this cycle? Please include the tool and results below.
Click to enter tool names here)
1a. Please include any visuals of your completed tools below:

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Project charter or aim
statement
Root Cause Analysis
SWOT Analysis
Force Field Analysis
SIPOC Diagrams (Six
Sigma)
Driver diagrams
Plan
Priority Matrix
Failure Mode & Effects
Analysis (FMEA)
Situation-Background-
Assessment-
Recommendation Tool
(SBAR)
Do
•Describe current processes:
Flow Charts
Spaghetti Map
Patient Journey Mapping
•Collecting and displaying data:
Run Charts
Control Charts
Histograms
Scatter Diagrams
Pareto Charts
Radar Charts
Study
Teach-back
Control Plan
Storyboards
Standard Work outlines
Act




(Please copy and paste the table above to include more cycles)


Example tools for each stage: