There are these two young fish swimming along, and they happen to meet an older fish swimming the other way, who nods at them and says, “Morning, boys. How’s the water?” And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes,

“What the hell is water?”

The point of the fish story is merely that the most obvious, important realities are often the ones that are hardest to see and talk about....The fact is that in the day to day trenches of adult existence, banal platitudes can have a life or death importance. (Story adapted from David Foster Wallace)

We exist in heath systems (from micro systems to macro systems) that are prone to errors and suboptimal care. Mere hard work from well intended, kindhearted providers cannot change outcomes, it needs system improvement. We need eyes to see the flaws in the system and skills to redesign it for better & sustainable results.

-M.Ahsan Zafar, MD, MS
Faculty lead for improvement science track

This track offers the opportunity for Pulmonary & Critical Care fellows to develop skills through educational series & mentored project-based experience in quality improvement.

Improvement science is an interplay of appreciating the system with a new lens, managing people through a change, being guided by and understanding variations in data, and building knowledge through small tests of change. The goal of an improver is to design (and re-design) systems to improve outcomes in order to make healthcare safe, effective, patient-centered, timely, efficient and equitable.

First and second year: 

• Complete online course by IHI (Institute of Healthcare Improvement) open school (can be done during protected research time)

• Engage/ initiate a small-scale improvement project with mentorship guidance

Year 3:

• Complete advanced training in improvement science and leadership from the ‘Anderson Center for Health System Improvement’ from Cincinnati Children’s Hospital. This is a 6 month course and you will have 2 weeks per month dedicated for course and project work (Total 3 month research time spread over 6 month period)

• Initiate a small-medium scale improvement project with palpable results and a plan for sustainability

• Disseminate project work in form of scholarly output: abstract or manuscript

When he is not rounding in the ICU or mentoring burgeoning clinical improvers, Dr. Zafar leads an initiative to provide patient-level informational videos (in six different languages) on current disease matters- check out Dr. SMART Team on YouTube!

A number of current UC Pulmonary/Critical Care faculty and fellows have helped in the production of these videos.