Formal Quality Improvement Training Research Articles

Improving knowledge of quality and safety among general and acute care medicine advanced trainees through a brief quality improvement workshop

Introduction: Quality and safety is a core competency, yet there are limited formalised quality improvement (QI) courses for physician trainees offered in Australia. Methods: An introductory QI workshop was conducted for trainees at the Internal Medicine Society of Australia and New Zealand (IMSANZ) Conference 2022. The workshop covered principles of improvement science, QI tools and plan-do-study-act (PDSA) cycles. The contents were delivered through a small-group experiential learning format. Pre- and post-workshop surveys were administered to evaluate the participants’ perceptions and improvement in QI knowledge domains. Results: Thirty-five trainees attended the workshop. Of all respondents, none had received formal QI training previously. Statistically significant improvements in nearly all QI knowledge domains were noted in the post-workshop evaluation along with improvement in participants’ motivation to further learn QI processes relevant to their vocation. Conclusion: An introductory workshop can significantly improve knowledge and motivation to further learn QI amongst physician trainees.

Improving patient safety through mandatory quality improvement (QI) education in a family medicine residency programme

Although the American College of Graduate Medical Education (ACGME) requires that medical trainees acquire competencies in patient safety and quality improvement (QI), no standard curriculum exists. We envisaged that a...

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.

Determinants of Hospital-based Physician Participation in Quality Improvement: A Survey of Hospitalists in British Columbia, Canada

Abstract Objective: We aimed to understand the extent of hospitalist involvement in system improvement efforts across the province of British Columbia in Canada and provide insights into determinants of such participation. Materials and Methods: We designed a web-based survey and asked about individual, programmatic, and institutional characteristics that may facilitate or impair hospitalist involvement in quality improvement (QI) activities. The survey was sent to all individuals who participated in “hospitalist care” from January 2014 to February 2015, in the province of British Columbia, Canada. We conducted both quantitative and qualitative analysis of responses. Results: We received 57 complete responses to the survey of 322 invited individuals (17.7% response rate). Of these, 15 individuals (26.3%) indicated that they had participated in QI initiatives. Respondents highlighted high clinical workload and lack of time, lack of QI skills and training, lack of access to performance data, poor support from hospital/health authority administration, and lack of financial compensation as main barriers to QI involvement. These themes were also supported in logistic regression, where QI training and the number of weeks worked as a hospitalist showed significant predictive properties for involvement in QI initiatives. Conclusion: Our study attempts to understand the various individual or organizational attributes that could facilitate involvement by hospital-based generalist physicians in QI activities. Our findings show lack of formal QI training is an important barrier for hospitalist involvement in QI, and highlight the need for formal training, dedicated time, support from physician leadership, and financial incentive as important facilitators for participation in systemic improvement efforts.

Creation and implementation of a chief fellow of quality improvement in an oncology fellowship program.

152 Background: Educating oncology trainees in methods and practical applications of quality improvement (QI) is essential. QI is a key component of the ACGME core competency of systems based practice. Formal QI training helps oncologists deliver safe and effective cancer care. Creating a QI chief fellow position allows for patient safety and QI initiatives to be fellow-driven and focused on building lifelong, oncology specific, QI skills. Methods: Feedback was solicited from the fellowship’s executive committee and divisional leadership to establish the job description and funding. Nominations were sought from peer fellows, focusing on a fellow who has expressed interest in QI, patient safety, and/or value based healthcare. The chief fellow was tasked with implementing a QI educational curriculum, developing a fellowship-wide QI project, and representing the fellowship on institution-wide QI and patient safety committees. Results: 100% (14/14) graduating fellows completed the requirements for an institutional clinical QI certificate by the end of the second year of the QI chief implementation, compared to 0% before the start of the implementation. 100% (27/27) of 1st and 2nd year fellows completed online training modules in QI. Biannual root cause analyses for patient safety events were initiated as a standard part of educational curriculum. 4 separate fellow-initiated QI projects were completed: oral chemotherapy patient education, opioid use and documentation, survivorship care plans, and infusion center usage. Fellows’ selection to the institutional clinical safety and effectiveness course increased from 4.8% (2/42) to 9.8% (4/41) in since implementation of the QI chief fellow. Fellowship representation on institution-wide patient safety committee increased from 0 to 2. Conclusions: Implementing a QI chief fellow role in an oncology fellowship is a feasible way to integrate a QI curriculum and provide structure for fellows to obtain further certification in QI or patient safety during fellowship. Ongoing challenges include encouraging enthusiasm from the entire fellowship for QI projects, finding appropriate QI mentorship from faculty, and translating QI initiatives into academic products.

Validity and Reliability of a Tool to Assess Quality Improvement Knowledge and Skills in Pediatrics Residents.

Residency programs are expected to educate residents in quality improvement (QI). Effective assessments are needed to ensure residents gain QI knowledge and skills. Limitations of current tools include poor interrater reliability and requirement for scorer training. To provide evidence for the validity of the Assessment of Quality Improvement Knowledge and Skills (AQIKS), which is a new tool that provides a summative assessment of pediatrics residents' ability to recall QI concepts and apply them to a clinical scenario. We conducted a quasi-experimental study to measure the AQIKS performance in 2 groups of pediatrics residents: postgraduate year (PGY) 2 residents who participated in a 1-year longitudinal QI curriculum, and a concurrent control group of PGY-1 residents who received no formal QI training. The curriculum included 20 hours of didactics and participation in a resident-led QI project. Three faculty members with clinical QI experience, who were not involved in the curriculum and received no additional training, scored the AQIKS. Complete data were obtained for 30 of 37 residents (81%) in the intervention group, and 36 of 40 residents (90%) in the control group. After completing a QI curriculum, the intervention group's mean score was 40% higher than at baseline (P < .001), while the control group showed no improvement (P = .29). Interrater reliability was substantial (κ = 0.74). The AQIKS detects an increase in QI knowledge and skills among pediatrics residents who participated in a QI curriculum, with better interrater reliability than currently available assessment tools.

Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows' Applied Quality Training (FAQT) Curriculum.

Training in quality improvement (QI) is a pillar of the next accreditation system of the Accreditation Committee on Graduate Medical Education and a growing expectation of physicians for maintenance of certification. Despite this, many postgraduate medical trainees are not receiving training in QI methods. We created the Fellows Applied Quality Training (FAQT) curriculum for cardiology fellows using both didactic and applied components with the goal of increasing confidence to participate in future QI projects. Fellows completed didactic training from the Institute for Healthcare Improvement's Open School and then designed and completed a project to improve quality of care or patient safety. Self-assessments were completed by the fellows before, during, and after the first year of the curriculum. The primary outcome for our curriculum was the median score reported by the fellows regarding their self-confidence to complete QI activities. Self-assessments were completed by 23 fellows. The majority of fellows (15 of 23, 65.2%) reported no prior formal QI training. Median score on baseline self-assessment was 3.0 (range, 1.85-4), which was significantly increased to 3.27 (range, 2.23-4; P = 0.004) on the final assessment. The distribution of scores reported by the fellows indicates that 30% were slightly confident at conducting QI activities on their own, which was reduced to 5% after completing the FAQT curriculum. An interim assessment was conducted after the fellows completed didactic training only; median scores were not different from the baseline (mean, 3.0; P = 0.51). After completion of the FAQT, cardiology fellows reported higher self-confidence to complete QI activities. The increase in self-confidence seemed to be limited to the applied component of the curriculum, with no significant change after the didactic component.

Abstract 232: Postgraduate Education in Quality Improvement Methods: Initial Results of the Fellows’ Applied Quality Training Curriculum

Background: Formal training in quality improvement (QI) methods is sporadic in medical educational settings. QI is a growing expectation for individual professional certifications and facility accreditations; future physicians will need to understand and apply QI methods as part of their practice. We developed a curriculum with both didactic and applied components to teach QI methods to cardiology fellows. Methods: The Fellows Applied Quality Training (FAQT) curriculum started in July 2013 with an initial cohort of 23 postgraduate trainees in general and subspecialty cardiovascular medicine fellowships. The FAQT is a multifaceted QI curriculum consisting of online learning modules, didactic training, and the start-to-finish completion of a team-based, self-directed quality improvement project under supervision of a faculty mentor. Trainees completed selected modules from the Institute of Healthcare Improvement Open School including basic terminology and background of QI methods. Trainees were assigned to small groups and challenged to identify an area in need, design an intervention to improve quality or safety, select an appropriate metric to measure, determine how to acquire the necessary data, implement their plan, analyze data to measure their success, and formally present the results. Prior to, during, and at the completion of the FAQT, trainees completed the 13 question self-assessment from the Quality Assessment and Improvement Curriculum. This assessment asks participants to rate their confidence to perform QI activities independently. The primary outcome of our investigation was an increase in the median confidence score reported on a 4 point scale (1=not at all confident, 2=slightly confident, 3=moderately confident, 4=extremely confident) compared by Wilcoxon signed rank test. Results: Prior to the FAQT, 15 trainees reported no prior formal QI training. Of those with prior training, 4 were practical and 4 had only didactic training. At baseline, the median score given on the assessment was 3.0. After completion of online training modules, the median score did not increase (3.0, p=0.51). At the conclusion of the self-directed projects, average confidence was higher (3.27, p=0.004). The proportion of fellows reporting they were “extremely” confident about using quality assessment and improvement in your future career increased from15% to 50% while the proportion reporting “slight” confidence decreased from 30% to 5%. Conclusion: At our institution, the majority of post-graduate medical trainees had no formal exposure to QI training. After completing a curriculum with practical application of QI methods, trainees reported an increase in their self-confidence to independently conduct QI; no increase was observed with didactic training alone.

Quality Improvement in Local Health Departments

To assess the current status of quality improvement (QI) within local health departments (LHDs) and examine the characteristics associated with such QI efforts. A QI module was administered to a representative sample of 545 LHDs along with the core instrument in the 2008 NACCHO Profile survey of all LHDs nationally. Using the Profile survey data set, a quantitative approach was employed to determine the current status of QI within LHDs. Statistical analysis was performed to identify characteristics of LHDs associated with QI. The response rate to the QI module was 82 percent. Of the 448 LHDs that responded to the QI Module, 55 percent reported conducting formal QI efforts during the previous 2 years. Forty-four percent of these LHDs used a specific framework for QI, 56 percent used at least one of four commonly employed QI tools or techniques, and customer focus and satisfaction was the most frequently reported area (76%) of QI efforts. LHDs with large size of jurisdiction population and those with centralized governance were more likely to have engaged in quality or performance improvement, have managers who received formal QI training, and have provided QI training to staff. The 2008 NACCHO Profile QI module furnishes an excellent baseline for measuring progress of health department QI activities as accreditation and other related activities intensify. A clear definition of QI in public health that is understood by practitioners will greatly increase our ability to measure the adoption of QI by LHDs. Further research is necessary to identify and explore some of the predictors and possible barriers to increasing the application of QI by LHDs.