Challenges and Barriers to Implementation of Reliable Interventions for DFI

The Ten Commandments of Diabetic Foot Infection QI

1. Thou shalt not fail to engage appropriate stakeholders, including frontline workers.
   
   
2. Thou shalt not fail to sufficiently study/understand the complexity and nuances of the problem (inadequate process mapping, etc.). For example, patients admitted with diabetic foot infections may be coded under a plethora of DRGs.
   
   
3. Thou shalt not fail to generate sufficient institutional/C-suite support.
   
   
4. Thou shalt be cognizant of potential resistance to inpatient care by podiatry in institutions where this has traditionally been an outpatient-only discipline.
   
   
5. Thou shalt ensure a well-coordinated transition from inpatient to outpatient care.
   
   
6. Thou shalt recognize financial (and potentially space) hurdles, for example, in setting up a multidisciplinary DFI clinic.
   
   
7. Thou shalt not allow the interventions to become overly complex for the end user and/or excessively complicate care delivery to patients with DFIs. Stated slightly differently, interventions should strive to be time neutral for their frontline users.
   
   
8. Thou shalt not fail to adequately design reliability into the system (i.e., by making improvement and “holding the gains” solely dependent on vigilance and hard work). Investing more money or “paying more attention” is generally not the correct solution.
   
   
9. Thou shalt not fail to adequately pilot the interventions prior to large-scale rollout.
   
   
10. Thou shalt adequately measure, analyze, and present results and then modify interventions accordingly. Remember that successful quality improvement generally stems from multiple small changes over time rather than from one sweeping change.