Quality Improvement Competencies Research Articles

Self-efficacy in Quality Improvement Competency of Frontline Acute Care Registered Nurses.

Registered nurses (RNs) are attuned to health care quality and safety concerns but may lack competency in quality improvement (QI) to advance care quality. To describe frontline acute care RNs' self-efficacy in QI competencies, evaluate differences based on educational attainment, and evaluate relationships based on years of RN experience. The study used a descriptive, quantitative, correlational, comparative cross-sectional survey design to evaluate RNs' self-efficacy in QI competency using the 2021 American Association of Colleges of Nursing The Essentials : Core Competencies for Professional Nursing Education . Frontline RNs' overall QI self-efficacy showed variability in knowledge, skills, and attitudes, with no relationship between self-efficacy and years of RN experience, nor difference based on educational attainment. Insufficient self-efficacy signals the need for further QI focus in nursing education, nursing practice, and health care policy to harness RNs' ability to advance care outcomes.

Original Research: Exploring Frontline Nurses' Self-Perceived Levels of QI Engagement and QI Competence.

Nurse engagement in quality improvement (QI) is critical in the delivery of safe high-quality care, yet few studies have evaluated frontline nurses in this area. The purpose of this study was to identify and compare levels of self-reported QI engagement and QI competence among frontline nurses and nurse leaders. This study used a cross-sectional descriptive design. A convenience sample of frontline nurses (bedside RNs and advanced practice nurses) and nurse leaders from acute and ambulatory care sites completed the Nursing Quality Improvement in Practice (NQuIP) tool, which measures engagement and competence (knowledge, skills, and attitudes) in QI. Data from 6,351 surveys completed by frontline nurses and nurse leaders representing 66 sites nationwide were analyzed. Only 52.5% of all respondents reported participating in QI. Knowledge scores were relatively high, while skills scores-especially those related to using QI tools-were low. Overall attitudes toward QI were positive. Nurse leaders scored significantly higher in engagement and competence than the frontline nurses they supervise. The study findings indicate that nurse engagement in QI is limited. Although nurses' knowledge levels appear to be high, their limited competency in QI-related skills may contribute to low QI engagement. Leaders must make efforts to increase nurse engagement in order to attain high-quality outcomes. Using the NQuIP tool will allow leaders to evaluate nurses' self-perceived QI competence and engagement, which will aid in identifying target areas and developing effective strategies for improvement.

A theoretical and practical approach to quality improvement education

Quality Improvement (QI) knowledge and skills are required at all levels of physician training. System improvement efforts need to include understanding of health disparities and design of interventions to reduce those disparities, thus health equity needs to be integrated into QI education. Payors, accreditation bodies and health systems’ emphases on QI result in the need for QI curricula that meet the needs of diverse learners. This article presents a theoretical background and practical tools for designing, implementing, and evaluating a QI educational program across the spectrum of physician training with an emphasis on competency-based education and a goal of continuous practice improvement. Practice-based learning and improvement and systems-based practice are two core domains of competencies for readiness to practice. These competencies can be met through the health systems science framework for studying improvement in patient care and health care delivery coupled with QI science. Curricula should incorporate interactive learning of theory and principles of QI as well as mentored, experiential QI project work with multidisciplinary teams. QI projects often develop ideas and implement changes but are often inconsistent in studying intervention impacts or reaching the level of patient outcomes. Curriculum design should incorporate adult learning principles, competency based medical education, environmental and audience factors, and formats for content delivery. Key QI topics and how they fit into the clinical environment and teaching resources are provided, as well as options for faculty development. Approaches to evaluation are presented, along with tools for assessing learner's beliefs and attitudes, knowledge and application of QI principles, project evaluation, competency and curriculum evaluation. If the goal is to empower the next generation of change agents, there remains a need for development of scientific methodology and scholarly work, as well as faculty development and support by institutions.

Participation in a multidisciplinary institutional committee, “RQUEST,” to enhance quality improvement education, project design, and implementation for hematology/oncology fellows.

e18733 Background: Participation in quality improvement (QI) projects allows medical trainees to develop an essential skillset to systematically analyze practice and implement changes with the goal of practice improvement. The ACGME designates QI education and participation as a core competency for all fellows. Training programs and institutions can vary significantly in QI educational format, participation, and direct support for project design and implementation. Here we present a description of the Resident Quality, Experience, and Safety Team (RQUEST) committee, which is being utilized by Hematology and Oncology fellows for QI project design and implementation at our institution. Methods: The first RQUEST committee was convened in August of 2021. RQUEST holds formal monthly meetings from August to June of each academic year. At the initial meetings, committee members are introduced to quality, safety, and patient experience structures and receive introductory training in QI tools and techniques. RQUEST members are then split into smaller project groups and work to select a QI project, perform current state analysis and baseline data collection, design and implement improvement interventions, and re-measure to determine the impact of the chosen interventions. The year concludes with each team presenting their project at a joint session to a larger audience of program directors, quality officers, service line directors, department chairs, graduate medical education staff, and hospital leadership RQUEST participation provides fellows with direct access to a multidisciplinary team and resources throughout project design and implementation. The timeline of monthly meetings provides both accountability and productive feedback. This facilitates the identification of system-specific opportunities for improvement and the most practical points of contact within the hospital, clinic, or EMR to design and apply quality interventions promptly and effectively. Results: We sent a voluntary survey to RQUEST participants, and 40% of participants responded to the survey. 100% of those who responded said participating in RQUEST has been beneficial in developing and implementing a QI project, and 100% said they would recommend participating in RQUEST to other medical trainees. The most common benefits listed were: · Structured approach/guidance · Institutional support and resources · A collaborative environment with a team of members from various departments, including IT. Conclusions: Fellow participation in a multidisciplinary QI committee at our institution has improved fellow QI education, participation, and project implementation. This engagement model has proven valuable to fellows and faculty in enhancing QI competency and clinical practice.

Using the QI Maturity Tool \u2013 Modified Ontario Version to assess the state of QI maturity in Ontario\u2019s public health units

BackgroundImplementation of quality improvement (QI) practices varies considerably among public health units (PHUs) in Ontario. With the emphasis on continuous quality improvement (CQI) in the revised Ontario Public Health Standards (OPHS), there is a need to understand the level of QI maturity in Ontario’s PHUs. The objective of this research was to establish a baseline understanding of QI maturity in Ontario’s PHUs.MethodsThe QI Maturity Tool - Modified Ontario Version was used to assess the state of QI maturity in 34 PHUs across Ontario. QI maturity was assessed through 23 questions across three dimensions: QI Organizational Culture; QI Capacity and Competency; and QI Perceived Value. QI maturity scores were classified into five stages: Beginning; Emerging; Progressing; Achieving; and Excelling. QI maturity scores were calculated for each of the 34 participating PHUs to determine their stage of QI maturity. Each PHU’s score was then used to determine the provincial average for QI maturity. Participants were also asked to answer three questions related to core CQI organizational structures.ResultsAcross the 34 PHUs, 3503 staff participated in the survey. A review of individual PHU scores indicates that Ontario’s PHUs are at varying stages of QI maturity. The average QI maturity score of 4.94 for the 34 participating PHUs places the provincial average in the “Emerging” stage of QI maturity. By QI dimensions, the participating PHUs scored in the “Emerging” stage for QI Organizational Culture (5.09), the “Beginning” stage for QI Competency and Capacity (4.58), and the “Achieving” stage for QI Perceived Value (6.00).ConclusionThere is an urgent need for Ontario’s PHUs to progress to higher stages of QI maturity. Participants place a high value on QI, but collectively are at less “mature” stages of QI in relation to QI organizational culture and the competency and capacity to engage in QI activities. PHUs should leverage the value that staff place on QI to foster the development of a culture of QI and provide staff with relevant knowledge and skills to engage in QI activities.

Healthcare Quality Improvement Competency: A Clinical and Training Imperative for Geropsychology.

Quality improvement (QI) work is increasingly necessary to ensure healthcare is delivered safely, efficiently, and equitably. As geropsychologists play an increasingly vital role in healthcare service delivery for older adults, it is imperative that they develop professional competence in QI, yet there is little formal QI training aimed at geropsychologists or to graduate students pursuing geropsychology. This article aims to elucidate the importance of QI education and training in geropsychology. In line with the Pikes Peak model for training in professional geropsychology, we outline QI knowledge and skills competencies for geropsychology training and suggest a rubric for integrating QI education into academic and clinical training from graduate school to professional practice. We provide recommended readings that geropsychology educators can read to become familiar with QI or use as part of a syllabus. Finally, we offer some recommendations for how current and future geropsychologists can be leaders in quality improvement work.

Role of Dutch internal policy advisors in a hospital quality improvement programme and their influence on nurses’ role development: a qualitative study

ObjectiveNurses are vital in providing and improving quality of care. To enhance the quality improvement (QI) competencies of nurses, hospitals in the Netherlands run developmental programmes generally led by internal...

Quality Improvement Education in the Era of COVID-19: A Pivot Toward Virtual Education.

Quality Improvement Education in the Era of COVID-19: A Pivot Toward Virtual Education.

Quality improvement engagement and competence: A comparison between frontline nurses and nurse leaders

BackgroundNurses play a pivotal role in improving patient care. To maximize nurses’ impact on quality, nurses must have quality improvement (QI) competence and engage fully in QI initiatives. PurposeTo describe QI competence (knowledge, skills, and attitudes) among frontline nurses and leaders; and compare variations in competence among nursing roles, experience, and specialty areas. MethodsA total of 681 nurses at one heath system fully completed the Nursing Quality Improvement Practice tool electronically. FindingsHalf of the respondents reported QI engagement (53.6%). Mean knowledge scores were 5.08 (SD 1.16, 7 items). Skill proficiency was low (M = 2.82, SD = 1.03; range 1–6) although QI attitudes were favorable (M = 3.76, SD = 0.63; range 1–5). Significant differences in skills and attitudes were identified by role. QI competence among nurses employed in various specialty areas were similar. DiscussionStrategies for increasing QI competence and engagement of nurses must be created and deployed in order to improve quality and safety.

Quality improvement: Online resources to support nursing education and practice.

Quality improvement (QI) competence is included in the American Association of Colleges of Nursing Essentials for pre-licensure and graduate degrees and is invaluable to nurses at all levels of professional practice. Among barriers to integration of QI competency is insufficient QI knowledge and skills among faculty and practicing nurses. Many nurses completed their nursing education before the introduction of the QI competencies in nursing programs, and it is understandable if they lack QI knowledge, skills, and attitudes. The purpose of this review is to provide information about QI online resources to nursing faculty, nurse leaders, and nurses in clinical practice with educational and training tools and opportunities to broaden their QI competence. The authors completed a comprehensive review of online resources for learning and/or teaching QI in health care and explored the websites of eight organizations. Within eight selected websites, the authors chose over 20 online self-study resources to learn and/or teach QI in health care with content for beginner, intermediate, and advanced learners. The QI online resources are easily accessible and can enable learning and engagement in QI of nursing faculty, students, and practicing nurses with no or limited exposure to the discipline.

Interprofessional Student Quality Improvement Project in a Federally Qualified Health Center.

Quality improvement (QI) and interprofessional competencies are needed to adequately prepare the health care workforce. A nurse-led, federally qualified health center provided university students from multiple health care programs a volunteer opportunity to collaborate on a QI project influenced by social determinants of health. Working in dyads, students surveyed patients to understand what they want to learn while waiting to see their provider. Analysis prioritized healthy lifestyles and nutrition topics. Students identified, provided, and evaluated culturally appropriate educational materials, including language and literacy in their preferred modality. A healthy lifestyles/nutrition video, recipes in English and Spanish, and a pamphlet were delivered. Patients deemed some materials helpful, and patients and staff provided feedback for the next project phase. Students achieved basic interprofessional and QI competencies and described project satisfaction. The hands-on approach allowed students to develop beginning interprofessional and QI competencies for their future professional practice. [J Nurs Educ. 2020;59(10):585-588.].

A Longitudinal Curriculum for Quality Improvement, Leadership Experience, and Scholarship in a Family Medicine Residency Program.

The Accreditation Council for Graduate Medical Education (ACGME) requires all residents be trained in quality improvement (QI), and that they produce scholarly projects. While not an ACGME requirement, residents need leadership skills to apply QI knowledge. We developed the Skills-based Experiential Embedded Quality Improvement (SEE-QI) curriculum to integrate training in QI, leadership, and scholarship. The University of Utah Family Medicine Residency Program began using the novel curriculum in 2012. The aim of the curriculum is to tie didactic teaching in quality improvement, leadership, and scholarship with skills application on multidisciplinary QI teams. Coaching for resident leaders is provided by faculty. Third-year resident leaders prepare academic presentations. Results of the ACGME Practice-Based Learning and Improvement (PBLI) 3 scores and number of scholarship presentations are described as a measure of efficacy. Two cohorts of residents completed the curriculum and all competency assessments. The average initial and final competency scores for competency PBLI-3 showed improvement and the average final competency for each cohort was above the proficient level. The residency requirements for QI scholarship did not change with introduction of the curriculum, but the amount of optional curricular QI scholarship and independent QI scholarship increased. The SEE-QI curriculum resulted in a high level of resident QI competency, opportunity for leadership training, and an increase in scholarship. We studied the results of this curriculum at one institution. Efforts to tie QI, leadership, and scholarship training should be evaluated at other programs.

Assessing Nursing Students' Perceptions of the QSEN Competencies: A Systematic Review of the Literature With Implications for Academic Programs.

Nurses are in key positions in the healthcare system to provide, monitor, and manage the care delivered to their patients. In 2005, the Quality and Safety Education for Nurses (QSEN) initiative was launched to redefine quality and safety competencies for pre-licensure nursing education. It is imperative that nurses are graduating with the full spectrum of the QSEN competencies to practice in today's healthcare environments. The purpose of this systematic review was to evaluate the research about student nurses' perceptions of their abilities to perform the six QSEN competencies and to determine the effect of integrating the QSEN content in their courses, clinical placements, or simulation experiences. A systematic review of the literature was conducted to retrieve published studies from CINAHL, PubMed, Web of Science, and ERIC using the search terms of Quality and Safety Education for Nurses, QSEN, QSEN competencies, nursing student, and student nurse. The studies that were included in this review were assessed by both authors independently using standardized critical appraisal tools. Seven studies met the inclusion criteria: four descriptive, one quasi-experimental, and two mixed-methods designs. Overall, pre-licensure nursing students perceived patient-centered care as the most discussed and quality improvement as the competency least reviewed in their curricula. Students reported to be most prepared to perform patient-centered care skills and least prepared to perform quality improvement skills. Revisiting the integration of the quality improvement competency into nursing curricula can increase nursing students' understanding of this QSEN competency. More research with sufficiently powered sample sizes, valid and reliable tools measuring outcomes of interventional studies, and attention to quality and rigor is needed to assess graduating students' understanding of the QSEN competencies.

Lessons Learned From Introducing Staff to Quality Improvement Through Systematic Training at the Boston Public Health Commission.

The widespread adoption of quality improvement (QI) in public health departments holds the promise of transformational change for the American public health system; however, there is a lack of published literature pertaining to organization-level experiences with introductory QI training programs for health department staff. This practice report aims to share the innovative approach, experience, and results of introducing staff to QI principles at the Boston Public Health Commission (BPHC). The BPHC is an accredited health department that introduced more than 80% of its 1100 staff members to QI between January 2015 and December 2018. The commission's QI training program benefited from (1) visible support from senior leaders, (2) well-documented QI training plans, (3) innovative QI training curricula, (4) flexible delivery methods, and (5) a responsive monitoring and evaluation system. To assess the effectiveness of QI training at the BPHC, participant questionnaires from QI training sessions (run between January 2015 and June 2018) and a separate questionnaire on organizational QI culture (administered to the supervisory staff in May 2018) were assessed using the Kirkpatrick model of training evaluation. On the basis of Kirkpatrick's 4 levels of training effectiveness, 91% of participants were satisfied with training content (level 1), 94% of participants found the facilitators effective (level 2), 84% of participants indicated they would apply QI concepts in everyday work (level 3), and 75% of supervisors reported an organization-wide improvement in QI culture (level 4). These results show that the BPHC's QI training program has been resoundingly effective, with positive outcomes across all 4 levels of the Kirkpatrick model. These results reinforce the idea of the BPHC's experience as an exemplar for introductory QI training. Interested health departments should heed the lessons learned from this and other organizational experiences as they attempt to scale up QI competencies among staff members.

Development of the Nursing Quality Improvement in Practice Tool: Advancing Frontline Nursing Practice.

Frontline nurse engagement in quality improvement (QI) improves nurse-sensitive outcomes; yet research suggests frontline nurses are not engaging in QI. The purpose of this study was to develop, refine, and psychometrically evaluate the Nursing Quality Improvement in Practice (N-QuIP) tool to measure nurses' competency, engagement, and barriers/facilitators to QI engagement. Item development was guided by an expert panel and literature review. Factor analysis and reliability indices were assessed through 681 surveys completed by nurses at one medical center. Cronbach α coefficients were 0.97 (Skill Scale) and 0.90 (Attitude Scale). Kuder-Richardson Formula 20 (KR-20) for knowledge was 0.36. Exploratory factor analysis identified 4 (Skill) and 3 (Attitude) subscales respectively, aligning well with QI competencies. Preliminary data suggest that the N-QuIP is a valid and reliable tool for assessing nurse QI competence and engagement. Understanding current knowledge, skills, and attitudes and identified barriers/facilitators can help the development of strategies aimed at increasing QI engagement.

A quality improvement collaborative to build improvement capacity in regional primary care support organisations

Strong primary care is foundational for effective, efficient health systems but remains variable in health systems around the world. Increasing quality improvement capacity in primary care support organisations has potential...

What Every Graduating Resident Needs to Know About Quality Improvement and Patient Safety: A Content Analysis of 26 Sets of ACGME Milestones.

Quality improvement (QI) and patient safety (PS) are broadly relevant to the practice of medicine, but specialty-specific milestones demonstrate variable expectations for trainee competency in QI/PS. The purpose of this study was to develop a unifying portrait of QI/PS expectations for graduating residents irrespective of specialty. Milestones from 26 residency programs representing the 24 member boards of the American Board of Medical Specialties were downloaded from the Accreditation Council for Graduate Medical Education (ACGME) Web site in 2015. A codebook was generated by in-depth reading of all milestone sets by two authors. Using a content analytic approach, milestones were then coded by a single author, with a 25% sample double coded by another author. Descriptive statistics were used to characterize frequency counts. Of 612 total milestones, 249 (40.7%) made mention of QI/PS. A median 10 milestones per specialty (interquartile range, 5.25-11.75) mentioned QI/PS. There were 446 individual references to QI, 423 references to PS, and another 1,065 references to QI/PS-related concepts, including patient-centered care, cost-effective practice, documentation, equity, handoffs and care transitions, and teamwork. QI/PS references reflected expectations about both individual-level practice (531/869; 61.1%) and practice within a health care system (338/869; 38.9%). QI and PS references were linked to all six ACGME core competencies. Although there is variability in the emphasis placed on QI/PS across specialties, overall, QI/PS is reflected in more than 40% of residency milestones. Graduating residents in all specialties are expected to demonstrate competence in QI, PS, and multiple related concepts.

Interprofessional QI Training Enhances Competency and QI Productivity Among Graduates: Findings From Nationwide Children's Hospital.

Significant resources are expended on quality improvement (QI) training courses. The authors sought to determine whether education provided in QI course training improves self-assessed QI content competence and QI-related productivity among course graduates. "Quality Improvement Essentials" is a four-month didactic and experiential course designed to prepare multidisciplinary professionals to participate in and lead QI efforts at Nationwide Children's Hospital (NCH). This study used a milestone-based self-assessment survey of graduates from 2012 to 2014 to gauge change in participants' self-assessed QI competency after course completion. Four competency domains were evaluated: QI knowledge; testing and implementing change using teams; data management and analysis; and spreading and sustaining science. Metrics for assessing individual QI productivity were presentation or publication of QI work outside NCH; local, regional, or national QI teaching; serving on a local, regional, or national QI committee; appointment as a QI leader; involvement in an internal or external QI collaborative; and leading a maintenance of certification Part IV project approved by NCH. Course participation more than doubled participants' self-assessed QI competence across all four domains. Gains continued after the course, increasing with time rather than degrading. Self-assessed competency increase was significantly associated with increased QI productivity. Self-assessed QI competence dramatically improved after participation in an educational course and continued to increase over time. Increased self-assessed QI competency correlated with increased individual QI productivity. Further studies are necessary to fully evaluate "return on investment" for this type of course.

SSET Project: Cost-effectiveness Analysis of Surgical Specialty Emergency Trays in the Emergency Department.

Background:We hypothesize that reusable, on-site specialty instrument trays available to plastic surgery residents in the emergency department (ED) for bedside procedures are more cost-effective than disposable on-site and remote re-usable operating room (OR) instruments at our institution.Methods:We completed a cost-effectiveness analysis comparing the use of disposable on-site kits and remote OR trays to a hypothetical, custom, reusable tray for ED procedures completed by PRS residents. Material costs of existing OR trays were used to estimate the purchasing and use-cost of a custom on-site tray for the same procedures. Cost of per procedure ‘consult time’ was estimated using procedure and resident salary.Results:Sixteen bedside procedures were completed over a 4.5 month period. A mean of 2.14 disposable kits were used per-procedure. Mean consultation time was 1.66 hours. Procedures that used OR trays took 3 times as long as procedures that used on-site kits (4 vs. 1.1 hours). Necessary, additional instruments were unavailable for 75% of procedures. Mean cost of using disposable kits and OR trays was $115.03/procedure versus an estimated $26.67/procedure cost of using a custom tray, yielding $88.36/procedure cost-savings. Purchase of a single custom tray ($1,421.55) would be redeemed after 2.3 weeks at 1 procedure/day. Purchasing 4 trays has projected annual cost-savings of $26,565.20.Conclusion:The purchase of specialized procedure trays will yield valuable time and cost-savings while providing quality patient care. Improving time efficiency will help achieve the Accreditation Council of Graduate Medical Education (ACGME) goals of maintaining resident well-being and developing quality improvement competency.

Assessing Student Perceptions of Quality and Safety Education for Nurses Competencies in a Baccalaureate Curriculum.

Nursing programs must ensure that graduate competencies in quality and patient safety are sufficient to meet practice needs. Student perceptions of the extent to which they acquired the knowledge, skills, and attitudes, as well as the importance and levels of preparedness associated with the Quality and Safety Education for Nurses (QSEN) competencies, were measured. Using a descriptive cross-sectional design, a convenience sample of 73 nursing students was surveyed using the QSEN Student Evaluation Survey tool. Students perceived being the least knowledgeable about, and least prepared to, engage in quality improvement (QI) activities. This competency was perceived as being the least important. Students reported they were somewhat prepared to perform all other skills related to QSEN competencies. Redesign of curricula emphasizing QI competencies is needed. A gap analysis identifying where in the curricula QI teaching is conducted and where it can be added may help ensure that students enter the workforce prepared to provide safe, quality care. [J Nurs Educ. 2017;56(7):435-438.].