Continuous Quality Improvement Process Research Articles

Continuous Quality Improvement in the Substance Abuse and Mental Health Services Administration's Technology Transfer Center Network: A Process Evaluation.

In healthcare and related fields, there is often a gap between research and practice. Scholars have developed frameworks to support dissemination and implementation of best practices, such as the Interactive Systems Framework for Dissemination and Implementation, which shows how scientific innovations are conveyed to practitioners through tools, training, and technical assistance (TA). Underpinning those aspects of the model are evaluation and continuous quality improvement (CQI). However, a recent meta-analysis suggests that the approaches to and outcomes from CQI in healthcare vary considerably, and that more evaluative work is needed. Therefore, this paper describes an assessment of CQI processes within the Substance Abuse and Mental Health Services Administration's (SAMHSA) Technology Transfer Center (TTC) Network, a large TA/TTC system in the United States comprised of 39 distinct centers. We conducted key informant interviews (n = 71 representing 28 centers in the Network) and three surveys (100% center response rates) focused on CQI, time/effort allocation, and Government Performance and Results Act (GPRA) measures. We used data from each of these study components to provide a robust picture of CQI within a TA/TTC system, identifying Network-specific concepts, concerns about conflation of the GPRA data with CQI, and principles that might be studied more generally.

Academic program enhancement supporting the success of undergraduate nursing students and graduates

Nursing program administrators, faculty, academic success coaches, and remediation specialists have implemented many interventions in support of baccalaureate nursing students' retention and graduates' NCLEX-RN® first-time pass rates. A private university's undergraduate nursing program's team incorporated additional evidence-based interventions aimed improving students' achievement of benchmarks following a 3-year decline in NCLEX-RN pass rates. Interventions expanded the prelicensure academic program's activities using a continuous quality improvement approach. A simulation center was constructed and a director was hired. A consultant also facilitated faculty engagement in curricular revisions. A new position, coordinator tutor/remediation specialist, was filled and the academic success coach launched interventions that complemented an initial and subsequent strategies for success initiative. New interventions were trialed and evaluated and became integral to students' and graduates' success. The academic success coach's commitment to students' achievements promoted their engagement in interventions. Pass rates increased and were sustained. Examples of interventions, supported by evidence, are presented in tables for review. A logic model depicts components of the program plan and its interventions as augmented by prospective strategies and remediation interventions. Continuous quality improvement processes will continue. Students and graduates have commented positively on the benefits of the assorted, success-promoting interventions.

Practitioner research as a pathway to educational leadership

ABSTRACT ‘Educational Leadership’ is embedded in [country] early childhood policy. What the role is, who should do it and why educators are hesitant about becoming leaders however, remains ambiguous. According to the national curriculum framework and teacher standards, more research about the work of educators is needed. The reported research aimed to investigate whether long-term, enquiry-based professional learning, utilizing practitioner research, could lead to quality improvement. Practitioner Research engaged educators in investigating and improving practice in a continuous process of quality improvement. Research topics were pedagogical in nature, designed to be enabling of ‘educational leadership’ for quality improvement. Action Research was used by practitioner researchers to investigate ways to improve pedagogical quality. University researchers also used meta-research to investigate the action research processes. Focus groups and mentor statements revealed unexpectedly that the Educational Leader role was pivotal in the relationship between professional learning, practitioner research and quality. Strengthened Educational Leader identities emerged as participants gained research skills and evidence for designing and implementing pedagogical change. Knowledge building facilitated strengthened engagement of educator teams. This was transformational, informing the case for change and further exploration of practitioner research as a workforce strategy for quality improvement and staff retention.

175 Benchmarking MICHR’s Clinical and Translational Science production as a continuous quality improvement initiative.

OBJECTIVES/GOALS: In line with NCATS funding requirements, the Michigan Institute for Clinical and Health Research (MICHR) established a continuous quality improvement (CQI) process and used the process to guide the implementation of a benchmarking project to evaluate and set goals for MICHR’s production of Clinical and Translational Science manuscripts. METHODS/STUDY POPULATION: We aimed to increase the number of Clinical and Translational Science papers MICHR produces and to set a reasonable goal for improvement. Benchmarking was used to obtain a baseline and inform the identification of a reasonable goal for improvement. 11 Peer institutions were identified with similar funding levels. 1,225 Publications from 2022 for all 12 CTSAs were obtained from NIH Reporter. All publications were reviewed by title to identify probable CTS content. Two staff reviewers confirmed a total of 108 CTS publications across all CTSAs, and coded each paper to characterize the theoretical approach, method (quantitative and/or qualitative), analytic method and topic. All publications that were selected for benchmarking were also tracked and compared using Altmetrics for Institutions and Overton platforms. RESULTS/ANTICIPATED RESULTS: A total of 108 CTS publications were produced by 12 benchmarked CTSAs in 2022; of those, 70% (77) regarded research infrastructure, 37% (41) regarded research methods, and 15% (16) regarded clinical care. Over half, 53% (58), of the benchmarked papers are empirical research papers; of those, 67% (39) used quantitative methods, 28% (16) used qualitative methods, and 5% (3) used mixed methods. A clear majority of the benchmarked papers, 70% (76), provided only descriptive analyses, 18% (19) provided inferential analyses, and 12% (13) provided predictive analyses. We identified an opportunity to produce more manuscripts with descriptive analyses of research infrastructure. In the long-term, we saw an opportunity to produce predictive analyses of translational initiatives designed to impact clinical care. DISCUSSION/SIGNIFICANCE: The benchmarking results helped MICHR identify goals for its production of Clinical and Translational Science to fill gaps in the field. Expanding the scope of this benchmarking project might achieve greater interrater reliability using larger representative sets of publications drawn from institutions across the CTSA Consortium.

The impact of accreditation on continuous quality improvement process in undergraduate medical education programs: A scoping review

Background Accreditation in medical education has existed for more than 100 years, yet the impact of accreditation remains inconclusive. Some studies have shown the effects of accreditation on student outcomes and educational processes at medical schools. However, evidence showing the impact of accreditation on continuous quality improvement of undergraduate medical education programs is still in its infancy. This scoping review explores the impact of accreditation on continuous quality improvement (CQI). Methods This scoping review followed the methodology of the Preferred Reporting Items of Systematic Reviews and the Meta-Analysis extension for scoping reviews (PRISMA-ScR) checklist outlined by Arksey and O'Malley (2005). Databases, including PubMed, Medline, ERIC, CINHAL, and Google Scholar, were searched to find articles from 2000 to 2022 related to the accreditation of undergraduate medical education programs and continuous quality improvement. Results A total of 35 full-text articles were reviewed, and ten articles met our inclusion criteria. The quality assurance approach is based on meeting the standards of accreditation. The quality improvement approach is based on striving for excellence. Literature suggests a requirement to move from student outcomes to CQI measures. CQI requires everyone in the organization to take responsibility and accountability, considering quality as the result of every single step or process and leaders supporting improvements in data collection and data analysis for quality improvement. Conclusions The literature on accreditation and CQI are limited in number. More research studies are required to enhance undergraduate medical education accreditation practices' value to medical students, educators, academic leaders, programs, and the public. It was recommended that medical schools embrace the culture and vision perpetuated by the CQI process.

Using a Learning Collaborative Model to Improve Youth Psychiatric Residential Treatment

ABSTRACT As part of a transformation initiative, a behavioral health managed care organization partnered with 14 youth psychiatric residential treatment facilities (PRTFs) through a Learning Collaborative to support clinical training, family engagement, community integration, and medication monitoring. Self-reported progress toward sustainable implementation, monitored monthly, improved significantly over time (F = 15.05, p < .0001). Clinical and direct care PRTF staff (N = 1,580) received either in-person or virtual clinical training. Scores on a pre- and post-training knowledge test increased significantly for both in-person and virtual training (p < .001 for both), and training satisfaction was high. Percentage of youth with therapeutic family sessions per month did not change over the Learning Collaborative; this percentage began and remained high (Range: 90.71% to 93.37%). Strategies to engage youth and families in organizational governance increased significantly (e.g. including youth/family partners on staff and in program development). The number of partnerships between PRTFs and community-based behavioral health providers did not change over time. Instead, number of partnerships began and remained high (Range: 38.36 to 48.08). PRTFs also tracked medications monthly to develop internal systems to monitor prescribing practices. This study highlights the value of partnerships and the Learning Collaborative approach to support a continuous quality improvement process.

Where are we now? Evaluating the one year impact of an anti-racism curriculum review

Purpose Undergraduate medical education has had a call to action to acknowledge racist practices that are impacting learners throughout their training. In 2020, our school performed a detailed curricular review and provided recommendations to address racism in the curriculum. Many schools have now undergone a similar curricular review process, but little is known about whether suggested antiracist curricular changes impact faculty teaching behavior or the overall curriculum. Material and Methods In 2021, as part of the medical school’s annual educational quality improvement process, course directors were required to answer a question about the changes they made to address racism in their courses based on recommendations provided the year prior from an antiracism curricular review. The documented changes were analyzed for themes and then organized by course and curricular year. These changes were compared with the suggested recommendations to analyze the number and types of changes implemented after one year. To evaluate student perceptions of change the general comments from academic years 2019–2021 were reviewed. Results After 1 year, approximately, 74% of our school’s 328 anti-racism curricular review recommendations were implemented in courses. Over 80% were implemented in curricular year 1. The greatest number of recommendations implemented were related to the theme of critiquing the strength of evidence in race-based medical practices. The least amount change was made around the theme of challenging the biologic notion of race. Conclusions An antiracism curricular review followed by an embedded continuous quality improvement process can be an effective approach to address racism in medical school curricula. Addressing racism in medical education requires medical schools to regularly identify curricular gaps, faculty needs and monitor their progress.

Optimizing workflow of urgent stroke endovascular intervention: A focused lean six sigma project

IntroductionUrgent endovascular intervention is currently accepted as the primary and critical therapeutic approach to patients whose acute ischemic stroke results from a large arterial occlusion (LAO). In this context, one of the quality metrics most widely applied to the assessment of emergency systems performance is the “door-to-puncture” (D-P) time. We undertook a project to identify the subinterval of the D-P metric causing the most impact on workflow delays and created a narrowly focused project on improving such subinterval. MethodsUsing the DMAIC (i.e., define, measure, analyze, improve and control) approach, we retrospectively reviewed our quality stroke data for calendar year (CY) 2021 (i.e., baseline population), completed a statistical process control assessment, defined the various subintervals of the D-P interval, and completed a Pareto analysis of their duration and their proportional contribution to the D-P interval. We retooled our workflow based on these analyses and analyzed the data resulting from its implementation between May and December 2022 (i.e., outcome population). ResultsThe baseline population included 87 patients (44 men; mean age = 67.2 years). Their D-P process was uncontrolled, and times varied between 35-235 minutes (Mean = 97; SD = 38.40). Their door to angiography arrival (D-AA) subinterval was significantly slower than their arrival to puncture (AA-P) (73.4 v. 23.5 minutes; p < 0.01), accounted for 73% of the average length of the D-P interval. The group page activation to angiography arrival (GP-AA) subinterval accounted for 41.5% of the entire D-AA duration, making it the target of our project. The outcome population originally consisted of 38 patients (15 men; mean age = 70.3 years). Their D-P process was controlled, its times varying between 43-177 minutes (Mean = 85.8; SD = 34.46), but not significantly difference than the baseline population (p = 0.127). Their target subinterval GP-AA varied between 0-37 minutes and was significantly improved from the baseline population (Mean = 13.21 v. 29.68; p < 0.001). ConclusionsIt seems feasible and reasonable to analyze the subinterval components of complex quality metrics such as the D-P time and carry out more focused quality improvement projects. Care must be exercised when interpreting the impact on overall system performance, due to unexpected variations within interdependent subprocesses. The application of a robust and comprehensive LSS continuous quality improvement process in any CSC will have to include individualized focused projects that simultaneously control the different components of overall system performance.

Mentors Supporting Nurses Transitioning to Primary Healthcare Roles: A Practice Improvement Initiative.

Effective primary healthcare services have been identified by the World Health Organization as the most equitable approach to enhancing universal healthcare. Robust models of mentoring for registered nurses (RNs) transitioning to primary healthcare roles have yet to be described in the Australian context. A robust mentoring model can support RNs to fulfill their potential, bridging the gap between theory and practice. In 2015, the peak body for nurses in primary health care (PHC) began developing a transition to practice program, including embedded mentoring to support newly graduated and more experienced registered and enrolled nurses. This quality improvement study reports the experiences and perspectives of nurses participating as mentors in two separate offerings of the program delivered between 2019 and 2021. A two-phase concurrent mixed methods evaluation utilized data from pre- and post online surveys and post program meetings. Quantitative items underwent descriptive analyses. Thematic analysis of free-text responses and comments was conducted independently by two researchers. Mentors voluntarily provided self-report data and were informed that data is routinely collected to support continuous quality improvement processes for all programs. An Information Sheet informed mentors of data usage, confidentiality, and options to withdraw without penalty from the program at any time. Seventy-nine mentors were recruited to support two groups of nurses (N = 111). Mentor self-rated overall satisfaction with program participation was 86.67% (very or extremely satisfied). Mentors described being "witness to mentee growth," "having facilitated access to learning" and receiving "unexpected benefits" including personal and professional growth and enhanced enthusiasm for their role in PHC. The embedded mentoring reported in this article combined a focus on skills acquisition and professional identity with the provision of a range of resources and support activities. Sustainable mentoring programs will be an important mechanism for supporting the expanding roles required of nurses working in primary health.

ASSESSMENT OF DECISIONAL COMPETENCE IN DEMENTIA– A QUALITATIVE STUDY OF 60 EUTHANASIA CASES

Abstract The Netherlands allows euthanasia or assisted suicide (EAS) for people with dementia. The number of dementia EAS cases gradually increases every year, up to 288 cases in 2022. This practice remains controversial, as dementia is not directly lethal and may impair decisional competence. The Dutch euthanasia review committees (RTE) refer to Appelbaum and Grisso’s criteria for the assessment of decisional competence, but how these criteria are applied in clinical practice remains unknown. This study examined qualitatively which factors, and how, influence the judgment of decisional competence for EAS requests of people with dementia. Thematic analysis of 60 dementia EAS case summaries published online by the RTE between 2012 and 2021. Twenty patients had an advance directive and were decisionally compromised at time of EAS. Forty patients were decisionally competent at time of EAS, of which twenty also had an advance directive (purposive sampling). Two researchers independently coded all text related to decisional competence. A theoretical framework was developed. The four cognitive criteria of Appelbaum and Grisso were dimensional and cut-off points were influenced by six supporting factors that also directly impacted on competence assessment, i.e., level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and the patient-physician relationship. The number of involved physicians and executed investigations were two contextual factors. The multidimensionality and subjectivity of decisional competence assessment may pose ethical and legal challenges. Continuous quality improvement processes may be needed in daily care, including possibilities for reflection.

“Advancing a More Inclusive Blood and Transplant System for Marginalized Groups”: Development and Evaluation of a Transfusion Medicine Health Equity and Advocacy Curriculum

Introduction: Health advocacy is an important skill for healthcare professionals to develop, but is challenging to teach. Here, we describe the development &amp; evaluation of a curriculum to support healthcare professionals &amp; trainees to develop as health advocates through advancing health equity across donation products for marginalized groups. Methods: We developed a transfusion medicine health equity &amp; advocacy curriculum “Advancing a more inclusive blood and transplant system for marginalized groups”. This curriculum included two workshops focusing on advancing inclusion across donation products for 1) LGBTQIA+ &amp; 2) racialized peoples. The first workshop, “Building a more inclusive blood and transplant system for LGBTQIA+ peoples” outlined blood, stem cell, &amp; organ &amp; tissue donation in Canada for gay, bisexual, &amp; other men who have sex with men, starting from the historical policies &amp; the context in which they were first put in place, to today's policies &amp; where future policies may lie. The second workshop, “Addressing racial disparities in blood, stem cell, and organ &amp; tissue donor pools”, outlined disparities in donor pools across donation products, barriers to donation impacting racialized/ ethnic populations, &amp; structural racism in donation policies (i.e. policies which disproportionately impact racialized/ ethnic peoples). The workshops also presented content from national campaigns to engage LGBTQIA+ peoples (stemcellclub.ca/SavingLivesWithPride) &amp; Black peoples (stemcellclub.ca/BlackDonorsSaveLives) to donation (Figure 1). Both workshops concluded with facilitated discussion groups supporting participants to reflect on donation policies for marginalized groups &amp; their consequences, &amp; how to help overcome barriers to donation. The curriculum was published to stemcellclub.ca/training &amp; piloted with a national cohort of Canadian medical students. Quantitative &amp; qualitative analyses (using a thematic analysis approach) were conducted to evaluate participants' perspectives on the impact of the workshop on their development as health advocates. Results: We hosted these workshops at 9 medical schools across Canada 10/2020-3/2023. 142 medical students participated, of whom 103/142 completed pre- &amp; post- workshop surveys (73% response rate). 64/103 (62%) of survey respondents were female, 47/103 (46%) identified as racialized or LGBTQIA+, &amp; 86/103 (83%) were pre-clerkship with 17/103 (17%) in clerkship. Results from quantitative &amp; qualitative analyses of participants' perspectives on the role of these workshops in their development as health advocates are shown in Table 1A-B. Nearly all participants strongly agreed/ agreed the workshops supported their development as health advocates (101/103, 98%), including the abilities to: advocate for patients beyond the clinical environment; work with patients/ communities to address &amp; identify determinants of health that affect them; respond to the needs of communities/ populations by advocating with them for system-level change; apply a process of continuous quality improvement to health promotion activities; &amp; contribute to a process to improve the health of a community/ population they will serve. Nearly all felt that the workshop should be incorporated into medical curricula (99/103, 96%). Following each workshop, a subset of medical students (n = 38 for each) participated in focus groups to share their perspectives on what they learned. Qualitative analysis identified rich examples of participants' development as health advocates through their participation in the workshops, across the following themes: prioritize inclusion; recognize discrimination; understand barriers to change; collaborate with advocates from diverse communities to address disparities; &amp; build a culture which supports inclusion. Conclusion: We present the first-ever curriculum in health equity in transfusion medicine to our knowledge, focusing on advancing inclusion across donation products &amp; addressing disparities impacting patients &amp; donors from marginalized groups. We also share the perspective of a national cohort of medical students in Canada that their participation in this curriculum contributed to their development as health advocates. This workshop is a model for teaching health advocacy to healthcare professionals &amp; trainees, and is relevant to a wide audience across medicine.

Building Quality Improvement Initiatives through Anti-Cancer Stewardship in the Veterans Health Administration (VHA): CML Pilot

The Department of Veterans Affairs (VA) Pharmacy Benefits Management (PBM) Services created a national stewardship with focus on anti-cancer therapeutics within a disease-specific cohort . Directing stewardship initiatives to a cohort of Veterans with a common malignancy is a novel approach. A multidisciplinary team with National PBM and VISNs (Veterans Integrated Service Network) promotes standardization of practice with accountability to monitor outcomes as a continual quality improvement process. A toolkit was built to support stewardship activities and includes: near-real-time process to identify a national disease-specific Veteran cohortdisease validation processcentralized MUE data collectioneducational resourcessite for communication and training materials Tyrosine Kinase Inhibitors (TKIs) account for the second highest utilization among outpatient oral anti-cancer therapies in VHA . Imatinib has demonstrated persistent efficacy and is the preferred TKI on the VA National Formulary. Utilizing our toolkit, we developed two MUEs for our national CML cohort to determine why Veterans were not prescribed imatinib as 1L therapy and reasons for switching from first to second line therapy. Methods Business rules identified VISN CML cohorts by using data sources and diagnostic coding from the VA Electronic Health Record (EHR): primary care and hematology/oncology visits (ICD-10), inpatient stays (ICD-10), and problem lists (ICD-10; SNOMED CT). Retrospective chart review of two subsets: Veterans who received a drug other than imatinib as their initial VA prescriptionVeterans who received at least two unique drugs to treat CML Data abstracted for MUE #1: Disposition of TKI prescriptionIf new initiation, documented reason(s) for drug selectionIf continuation, prior drug therapy history Data abstracted for MUE #2: Documented reason(s) for switch to 2LIf adverse drug reaction (ADR) included as a reason, is it documented in the EHR? Analysis combined responses with prescription data from the EHR. Results Of the 18 VISNs, 9 participated in MUE data collection. 365 patients were identified as not having received imatinib 1L and 360 were identified as having received at least two unique drugs to treat CML. These counts are each approximately 30% of the total CML patient cohort. In the total cohort, ~50% of patients received imatinib 1L and have not switched to 2L. Responses for 1L TKI therapy (N=365) 199 (55%) continued therapy originally started outside VA with 67% of these patients (n=133) without documentation of prior imatinib therapy166 (45%) were newly initiating CML therapy with top documented reasons for drug selection: Intermediate or high risk (e.g., SOKAL risk scoring): 77 (46%)46 (28%)18 (11%)Dasatinib was the most prescribed 1L therapy in this cohort (64%; 235), followed by nilotinib (23%; 85), which had a higher prevalence when therapy was continuation (30%).53 patients (15%) had subsequent imatinib therapyResponses for switch from 1L to 2L therapy (N=360) Top documented reasons for switch from 1L to 2L therapy 215 (60%)81 (23%)Resistance / inadequate response: 69 (19%)Only 37 (17%) who experienced an ADR had it documented in the EHRThe most common 2L drug was dasatinib (55%;198). The median number of days between 1L and 2L initiation was 275 (range: 7 - 2, 573)136 patients (38%) received third line therapy or beyond Conclusions A formalized oncology stewardship with focus on disease-specific initiatives within a national healthcare system is feasible. Responses from our 1L MUE indicate that despite geography, imatinib remains the preferred TKI and accounts for the highest utilization. Most veterans not receiving imatinib as 1L therapy, received dasatinib or nilotinib. Continuation of therapy due to transition of care to VA was the primary reason for 1L therapy with a non-preferred TKI. Other reasons included: FDA indication and SOKAL risk scoring. In our pilot 1L to 2L MUE, ADRs were the most common reason for CML patients to be switched to 2L (45%) followed by resistance/inadequate response and disease progression . Most ADRs were not documented in the EHR. Further interventions in TKI prescribing may be instituted in select sites . Following initiatives for CML, Anti-Cancer Stewardship will be expanded to other oncologic diseases.

Regional public health staff workplace psychosocial risk assessment and health promotion initiative

Abstract Psychosocial work conditions can be detrimental to worker wellbeing with 70% of healthcare workers reporting work related stress, which may lead to burnout. Despite European health and safety legislation, managers rarely assess and manage workplace psychosocial risks. The Public Health workforce in Ireland, already impacted by the pandemic, is currently experiencing major organisational change as a result of the ongoing Public Health Reform Process. This paper describes the structures, processes and outcomes involved in a Public Health staff (n = 56) workplace psychosocial risk assessment, guided by the European Framework for Psychosocial risk Management: PRIMA-EF, using the HSE Work Positive CI psychosocial risk assessment survey. The establishment of a multidisciplinary Health &amp; Wellbeing (H&amp;W) group, under the governance of the Area Senior Management Team, was key to guide the process, including a workplace health promotion initiative, influenced by Positive Psychology framework (PERMA). The response rate to the survey was 70% (n = 40), with half of staff reporting psychological distress. Work stressors included role clarity, demand, change and control, scoring below average compared to Irish organisational norms. Relationships and manager support scored highly. The H&amp;W group shared results promptly with all staff and formulated iterative mitigation measures, including HSE Change Management and HSE Health &amp; Wellbeing consultants, based on the survey action plan and staff feedback. Five months later a repeat survey revealed continuing issues around role clarity and demands, with change and control showing an improvement. Further exploration of these results, and an evaluation, informed by staff feedback is ongoing and iterative. Lessons learnt include the importance of embedding a dedicated H&amp;W multidisciplinary group to lead the continuous process; senior management support; employee involvement and effective utilisation of existing organisational tools and supports. Key messages • It is a public health imperative to promote risk assessment and mitigation of healthcare workplace stressors to safeguard employee wellbeing and ensure health service resilience and patient safety. • Effective workplace psychosocial risk assessment and implementation of targeted mitigation measures requires management support and a continuous iterative collaborative quality improvement process.

Lessons learned from the metabolic and bariatric surgery accreditation and quality improvement program site surveys: common deficiencies and corrective actions

BackgroundThe Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) is a joint program between the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS). On-site surveys of the applicant programs to determine adherence to the MBSAQIP standards are a hallmark of the accreditation process. ObjectivesA retrospective review of 619 site surveys completed over 2 years was performed to include analysis of reviewer decisions, tabulation and cross-reference of identified deficiencies to the MBSAQIP standards and determine final disposition of corrective actions and overall accreditation rates. SettingAccredited Hospitals (Community and Academic) within MBSAQIP. MethodsThis is a retrospective review of site surveys by expert panel. Results≥1 MBSAQIP Standards deficiencies were present at 149 of the 619 program site surveys (24.07%). The 3 leading Standards in Deficiency were in order: Commitment to Quality Care, Continuous Quality Improvement Process, and Data Collection. Within a year following initial site survey of the149 programs with Standards deficiencies, 59 programs demonstrated compliance, 83 programs were placed on probation (with a specific time-frame to demonstrate compliance) and 7 programs were denied accreditation. Ultimately, 98.9% of programs were able to gain or maintain MBSAQIP accreditation. ConclusionsThe MBSAQIP accreditation through on-site surveys can identify and improve program adherence to MBSAQIP standards.

Electronic Incidence reporting impact on Quality and Patient Safety: Results of Quality Improvement Project at Yarmouk Health Care Center, Kuwait

At Yarmouk Primary Health Care Center (PHCC), a continuous quality improvement and patient safety system is in place. \ Health care delivery was explored and paper-based incident reporting was found to compromise patient safety and quality. Induction of electronic reporting of incidents was started and its favorable outcome demonstrated. This was followed by establishing a continuous quality improvement process at the facility. Ethical principles were followed during data collection and analysis. Electronic Incidence reporting was started in January 2022. A substantial increase (16 in paper-based versus 53 in electronic reporting) in Incidence reporting, following introduction of electronic reporting at Yarmouk PHCC was demonstrated. A reduction of time consumption from 35 minutes in paper-based Incidence reporting to 10 minutes in electronic reporting was demonstrated. An improvement in accuracy while using electronic Incidence report (94%) in comparison to that while using Paper based Incidence reporting (85%) was documented. Maximum Incidence reporting was by Pharmacy followed by doctors, administration staff and laboratory. Maximum Incidences were product related followed by investigation related. No sentinel event reporting was found. The majority of reported incidences were in “no harm” and “near miss” categories. Employee satisfaction improved with electronic Incidence reporting. Due to advancement of technology today, it is imperative and strongly recommended to use principles of quality improvement process to improve patient safety and quality of care. Electronic Incidence reporting is found to improve quality and patient safety. Further studies into impact of better utilization of electronic Incidence reporting on health care outcomes is strongly recommended. Key words: Patient safety; Quality Improvement; Electronic Incidence reporting; Paper-based Incidence reporting

Designing implementation strategies for the inclusion of LGBTQIA+ and key populations content in undergraduate nursing curricula in KwaZulu-Natal, South Africa: Protocol for a Multi-Methods Research Project.

Literature suggests that Lesbian, Gay, Bisexual, Transgender, Intersex, Queer and Allied (LGBTQIA+) individuals encounter challenges with access and engagement with health services. Studies have reported that LGBTQIA+ individuals' experiences stigma, discrimination and health workers' micro aggression when accessing healthcare. There is compelling evidence to suggest that the LGBTQIA+ community are faced with disproportionate rates of HIV infection, mental health disorders, substance abuse and other non-communicable diseases. The South African National Strategic Plan (NSP) on HIV/AIDS, TB and STI's (2023-2028) recognises the need for providing affirming LGBTQIA+ health care as part of the country's HIV/AIDS response strategy that is rooted in comprehensive and holistic care underpinned by the principles of community oriented primary healthcare. However, current anecdotal evidence suggests paucity of LGBTQIA+ and key populations health content in the undergraduate health science curricula in South Africa. Moreover, literature reveals a general lack of health worker training regarding the health needs of LGBTQIA+ persons and other key populations such as sex workers, People Who Inject Drugs (PWID) and Men who have Sex with Men (MSM). This protocol paper describes the design of a project that aims at facilitating the inclusion of health content related to the LGBTQIA+ community and other key populations in the undergraduate nursing curricula of KwaZulu-Natal, South Africa. A multi-methods design encompassing collection of primary and secondary data using multiple qualitative designs and quantitative approaches will be used to generate evidence that will inform the co-design, testing and scale-up of strategies to facilitate the inclusion of LGBTQIA+ and key populations content in undergraduate nursing curricula in KwaZulu-Natal, South Africa. Data will be collected using a combination of convenience, purposive and snow ball sampling techniques from LGBTQIA+ persons, academic staff, undergraduate nursing students and other key populations such as MSM, PWID and sex workers. Primary data will be collected through individual in-depth interviews, focus groups discussions and surveys guided by semi-structure and structured data collection tools. Data collection and analysis will be an iterative process guided by the respective research design to be adopted. The continuous quality improvement process to be adopted during data gathering and analysis will ensure contextual relevance and sustainability of the resultant co-designed strategies that are to be scaled-up as part of the overarching objective of this study. The proposed study is designed in response to recent contextual empirical evidence highlighting the multiplicity of health challenges experienced by LGBTQIA+ individuals and key populations in relation to health service delivery and access to healthcare. The potential findings of the study may be appropriate for contributing to the education of nurses as one of the means to ameliorate these problems. This research has potential implications for nursing education in South Africa and worldwide as it addresses up-to-date problems in the nursing discipline as it pertains to undergraduate students' preparedness for addressing the unique needs and challenges of the LGBTQIA+ community and other key populations. The findings may also provide baseline data to inform knowledge transfer to other health sciences disciplines that have not included LGBTQIA+ content in their undergraduate curricula in South Africa.

Medicines stewardship.

Medicines stewardship refers to coordinated strategies and interventions to optimise medicines use, usually within a specific therapeutic area. Medicines stewardship programs can reduce variations in practice and improve patient outcomes. Therapeutic domains for medicines stewardship are chosen to address frequently used drug classes associated with a high risk of adverse outcomes. Some examples include antimicrobial, opioid analgesic, anticoagulation and psychotropic stewardship. Common elements of successful stewardship programs include multidisciplinary leadership, stakeholder engagement, tailored communication strategies, behavioural changes, implementation science methodologies, and ongoing program monitoring, evaluation and reporting. Medicines stewardship is a continual quality improvement process that requires ongoing support and resources, as well as clinician and consumer engagement, to remain sustainable. It is critical for hospital-based medicines stewardship programs to consider impacts on care in the community when making and communicating changes to patient therapy. This ensures that stewardship efforts are sustained across transitions of care.

La coopération entre allergologues et biologistes membres du réseau AllergoBioNet : le succès d’un modèle français

AllergoBioNet is a French association of clinical laboratory specialists of allergic and mast-cell-related diseases and their differential diagnoses. Its 79 members are working in clinical laboratories in 29 Universitary Hospitals and 15 General Hospitals in France and another one in Belgium. Ten of these laboratories have recently been certified as «laboratoires de biologie médicale de référence » (Reference Clinical Laboratories, LBMR) to valorize the expertise in hypersensitivity, mast-cell and complement laboratory investigations. The first mission of these laboratory professionals is to ensure that results are accurate and reliable. Thus, they deal with all the process of continuous quality improvement and are able to minimize errors of the sample's workflow (pre-analytic, analytic and post-analytic phases). Since years, they are certified by the French Organization for Quality (COFRAC). Moreover, they evaluate newer diagnostic tests, ensure continuous medical formation to actualize competences and knowledge, participate in research protocols and publish in national and international specialized reviews. The aims of this article are (1) to encourage all medical laboratory specialists working in the field of allergic diseases (diagnosis, monitoring patients and responses to therapy) to join the AllergoBioNet network; (2) to encourage physicians to collaborate with these laboratory professionals, so that they could answer to practical questions (ie: pre-analytical needs and conservation samples), receive updates for state-of-the-art laboratory methods and devices, refer patients needing highly specialized analyses and ensure interdisciplinary interpretation of clinical and laboratory results. This partnership should improve mutual competences and contribute to patient care.

Understanding and Addressing Bias in Grading: Progress at Washington University School of Medicine.

In 2020, the authors published work examining disparities in clerkship grading and found students who identify as White were more likely to receive honors grades compared with students from races/ethnicities traditionally underrepresented in medicine. Through a quality improvement approach, the authors identified the following 6 areas where improvements could mitigate grading disparities and, therefore, put processes in place to: ensure equitable access to examination preparation resources, change student assessment, develop medical student curriculum interventions, improve the learning environment, change house staff and faculty recruitment and retention practices, and provide ongoing program evaluation and continuous quality improvement processes to monitor for success. While the authors cannot yet be sure that they have achieved their goal of promoting equity in grading, they believe this evidence-based, multipronged intervention is a clear step in the right direction and encourage other schools to consider a similar approach to tackling this critically important problem at their own institutions.

Facilitating person‐centred care: integrating an electronic client feedback tool into continuous quality improvement processes to deliver client‐responsive HIV services in the Democratic Republic of Congo

AbstractIntroductionEngaging communities in the design, implementation and monitoring of health services is critical for delivering high‐quality, person‐centred services that keep people living with HIV engaged in care. The USAID‐funded Integrated HIV/AIDS Project in Haut‐Katanga (IHAP‐HK) integrated an electronic client feedback tool into continuous quality improvement (CQI) processes. We aimed to demonstrate this system's impact on identifying and improving critical quality‐of‐care gaps.MethodsThrough stakeholder and empathy mapping, IHAP‐HK co‐designed a service quality monitoring system—comprising anonymous exit interviews and ongoing monitoring through CQI cycles—with people living with HIV, facility‐based providers and other community stakeholders. IHAP‐HK trained 30 peer educators to administer oral, 10‐ to 15‐minute exit interviews with people living with HIV following clinic appointments, and record responses via the KoboToolbox application. IHAP‐HK shared client feedback with facility CQI teams and peer educators; identified quality‐of‐care gaps; discussed remediation steps for inclusion in facility‐level improvement plans; and monitored implementation of identified actions. IHAP‐HK tested this system at eight high‐volume facilities in Haut‐Katanga province from May 2021 through September 2022.ResultsFindings from 4917 interviews highlighted wait time, stigma, service confidentiality and viral load (VL) turnaround time as key issues. Solutions implemented included: (1) using peer educators to conduct preparatory tasks (pre‐packaging and distributing refills; pulling client files) or escort clients to consultation rooms; (2) limiting personnel in consultation rooms during client appointments; (3) improving facility access cards; and (4) informing clients of VL results via telephone or home visits. Due to these actions, between initial (May 2021) and final interviews (September 2022), client satisfaction with wait times improved (76% to 100% reporting excellent or acceptable wait times); reported cases of stigma decreased (5% to 0%); service confidentiality improved (71% to 99%); and VL turnaround time decreased (45% to 2% informed of VL results 3 months after sample collection).ConclusionsOur results showed the feasibility and effectiveness of using an electronic client feedback tool embedded in CQI processes to collect client perspectives to improve service quality and advance client‐responsive care in the Democratic Republic of Congo. IHAP‐HK recommends further testing and expansion of this system to advance person‐centred health services.