HPV Lessons Learned

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Enhancing HPV Vaccination Through Quality Improvement


Lessons Learned from American Academy of Pediatrics’ Hub & Spoke Initiative Focused on Improving HPV Rates

To improve HPV vaccination rates, the AAP has implemented the Hub and Spoke Initiative Focused on Improving HPV Rates. As part of this initiative, QI concepts are applied and spread within pediatric practice through AAP chapter-led projects. These lessons learned are designed to help individuals and teams planning and/or implementing an HPV vaccination QI project in practice. It highlights lessons learned by AAP chapters about QI project design and valuable approaches.

    HPV Vaccination QI Project Design

    Set the right timeline

    • Develop a project that is long enough to see improvement but not too long to be a barrier for participation, such as a six-month QI project.

    Motivate and incentive

    • To boost office recruitment, incentives may include Maintenance of Certification (MOC) Part 4 credit, small grants to participating practices, and QI coaching provided at no cost to the practice. Incentives should not inhibit sustainability or spread of the project.

    Create clear project requirements

    • Be clear from the beginning about requirements for QI project completion. Clarity about the details of the requirements (eg, number of charts to review, project due dates) is essential for participating practices to plan appropriately and know what to expect throughout the duration of the project.

    Provide QI education

    • Project participants should receive education in fundamental QI principles and tools needed to improve processes in the practice. One useful QI tool is Plan, Do, Study, Act (PDSA) cycles, which encourage project participants to rapidly test their ideas for change on a small scale to help determine if that change leads to improvement.

    Develop a strong aim statement

    • Facilitate adoption of a clear, focused, and appropriate goal. An aim statement focuses on what you are trying to accomplish and brings the scope of the project to a manageable size. A clear aim statement is essential for communication to flow smoothly between all stakeholders.

    Integrate sustainability and spread principles

    • Introduce sustainability and spread principles early in the project. Sustainability addresses how to maintain improvement efforts, and spread establishes structures and processes that promote and support successful changes throughout a practice or organization.

    Utilize data to monitor progress

    • Data allows for monitoring of progress. Specifically, run charts graphically display data over time, which can be used to facilitate learning and discussion about a practice change that was implemented.

    Valuable Approaches

    Involve all office staff in QI efforts

    • All staff, including non-clinical staff, should be involved in  improvement efforts. To optimize a strong provider recommendation and increase vaccine acceptance, all staff need to understand the importance of the HPV vaccine and communicate the same  message to parents.

    Communicate the right message

    • Communicating the right  message to parents is essential to reaching high immunization rates. An effective recommendation includes messaging such as "HPV vaccination is cancer prevention" and introducing the HPV vaccine in the same way, on the same day as other adolescent vaccinations.

    Engage a QI coach

    • A QI coach can help staff learn the essentials of QI and guide practice efforts as well as add a sense of accountability and  ownership to a project.

    Hear from survivors of HPV-associated cancers

    • Statistics about HPV-associated cancers are interesting, but human stories are compelling. During staff meetings or lunch and learns, share stories by showing American Cancer Society HPV cancer survivor videos or invite a cancer survivor who is willing to speak.

    Encourage collaboration

    • Sharing resources and collaborating across AAP chapters, organizations, or projects can help maximize the cost-effectiveness of projects.
      • For example, the costs for a QI coach, practice incentives, and office recruitment strategies can be shared.

    Share materials

    • Creating new materials can be time consuming, so a practical approach is to use existing materials from the AAP, CDC and others.


Updated December 2018