Today was another thought provoking day in Breckenridge.  While I found pearls in all the of the sessions, I think my favorite two sessions were the talk by Shelly Dierkling on QI projects and the discussion led by John Nance.  As a graduate nursing student in the Health Care Systems Clinical Nurse Leader Track at UNC, I had been tasked with developing a QI project as part of my program prior to being selected for this camp.  Last semester I was given a model to follow, the Dartmouth Model, and tasked with discovering a clinical need that would improve the quality of care provided by the clinic I work in.  I completed the task and presented all the right deliverables, but at the end of the day I didn’t have a lot of confidence that the project I am hoping to implement will actually gain traction.  Shelly’s comment that a project must take into consideration and operate with an awareness of the culture it is being implemented in, really hit home for me.  I think this was one of the items missing in my assessment and one that is vital to the success of every patient safety/QI project.  You are not going to change a culture overnight, but when you begin to make changes, as John stated, you can let off the throttle or the system will revert back to the old way of doing things.  These discussions provided a critical insight into how to more effectivly accomplish my goals and implement my PDSA next semester–to make my project a part of our culture, I have to make the existing culture a part of my project.