Quality Improvement Education Research Articles

Creating Impact in Surgery

Thank you for reading the latest edition of Impact Surgery. We are committed to fostering a platform that amplifies the voices and experiences of surgeons and researchers from across the world. In line with this vision, we are seeking pilot studies, global surgery studies, quality improvement projects, reviews, education, and deeper dives on surgical topics that are often overlooked or neglected elsewhere. We recognise the profound impact of surgical interventions on individuals, communities, and societies worldwide, and we hope to speed up solutions and policy changes to address the unique challenges faced by diverse populations.

A graduate medical education (GME) quality improvement curriculum leads to improved knowledge and participation in high quality improvement projects by trainees

BackgroundThere is increased awareness about the need for quality improvement (QI) education for trainees within clinical training programs. However, formal integration of a QI curriculum into graduate medical education (GME) remains a work-in-progress. We describe the creation and implementation of a novel, virtual QI curriculum complemented by virtual-based workshops. ObjectiveTo determine the impact of a GME QI curriculum on 1) trainee QI knowledge; 2) Quality of QI projects. MethodsThe GME Quality Improvement curriculum was transitioned to an optional formal curriculum in 2020. It is led by three faculty with expertise in QI training and education. The team developed four, web-based learning modules that focused on fundamental QI concepts. These modules are completed monthly and are paired with virtual workshops that facilitate applying learned QI concepts to project development.We evaluated the effectiveness of the curriculum by assessing participants’ performance on knowledge-based quizzes before and after each online module. We used IBM SPSS (version 28), to conduct a two-sided paired samples t-test, comparing each post-session test scores with their corresponding pre-session scores. The alpha, or statistical threshold significance threshold, was 0.05.Additionally, two independent judges with expertise in QI evaluated the quality of the projects presented at the annual QI showcase using a standardized scoring rubric. The poster evaluation forms included 8 questions, rated on a scale from 1 to 5. Projects were graded into 4 quartiles (poor, fair, good, excellent). ResultsIn the knowledge assessment quiz, the difference between the mean pre- and post-session quiz scores was statistically significant (p < 0.01). The average score of the quality of the projects presented at the annual showcase was 31, in the fourth quartile which was graded as “excellent” quality. ConclusionA GME-led QI curriculum was effective in improving knowledge of QI concepts and producing high-quality scholarly projects.

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...

Early Immersion in Team-Based Event Review: Experiential Patient Safety Education for PGY 1 Internal Medicine Residents.

In recent years, there has been a national push to incorporate high-fidelity quality improvement and patient safety (QIPS) education into physician training programs. In fact, integration of robust patient safety education became an Accreditation Council for Graduate Medical Education (ACGME) Common Program Requirement for residency programs in 2017. We developed a curriculum to not only fulfill the ACGME's requirement but also provide PGY 1 internal medicine residents with the skills needed to become active participants in ongoing patient safety work throughout their training and careers. Our patient safety curriculum was woven into residents' existing protected educational time and supported by a standardized facilitator guide and participant workbook. It combined didactic prework with the review of recent near-miss or low-harm patient safety events, empowering residents to identify root causes and propose interventions. We successfully delivered our patient safety curriculum to 80 PGY 1 residents over the course of 2 academic years. Residents rated the curriculum as a valuable educational experience, and the event reviews they completed met most of the criteria for high-quality patient safety reviews according to the Strong String Assessment. Implementation of this standardized curriculum has allowed us to reliably and consistently incorporate experiential patient safety education into the first year of training for internal medicine residents. Unlike purely didactic sessions, our curriculum encourages active learning, building muscle memory for event reviews that enables future engagement in patient safety activities.

Building pathology capacity in sub-Saharan Africa to improve breast cancer diagnosis and treatment: training laboratory technicians in high-quality manual immunohistochemistry

BackgroundTo address the need for a skilled workforce in breast cancer (BC) pathology in sub-Saharan Africa (SSA), we implemented an education program to train laboratory technicians in manual immunohistochemistry (IHC).MethodsA quality improvement education project was developed. Interactive webinars were held every six months with didactics and presentations from African experts with experience in IHC. We conducted knowledge assessments and surveys on current practice, equipment, and human resources. A digital mentorship platform (DMP) was created for discussions, sharing SOPs, and networking. For one year (2022–2023), we followed developments in pathology capacity, practice changes, and educational needs. A paired t-test was used to calculate the significance of changes in knowledge immediately after the webinar and comfort level with topics 35 days after the webinar.ResultsTwo hundred and sixty six participants from 10 SSA countries attended the first webinar, a series of six lectures on IHC theory, methods, and practice. Ninety-five participants from nine SSA countries provided a baseline assessment of pathology capacity and feedback. Mean knowledge increased by 17.4% immediately after the webinar (from 41.8% pre-webinar to 59.2% post, p = < 0.0001). Self-reported comfort level in topics 35 days after the webinar increased by 11.3%, but this was not statistically significant (mean 3.36 pre- to 3.74 post, p = 0.1). Over six months, recordings were accessed 412 times. After six months, the second webinar had 93 participants from eight SSA countries. Membership in the DMP increased from 64 to 172; recordings were viewed 412 times in six months; and 113 participants from nine SSA countries completed surveys. Among 74 respondents who perform IHC, 43.5% reported moderate or significant positive practice changes such as improved antigen retrieval techniques and optimization of preanalytical variables. Over half (52.7%, n = 39) reported the quality of slides had moderately or significantly improved. After one year, a third webinar had 98 participants from eight SSA countries. Thirty-eight completed surveys, DMP membership increased to 199, and 1 reported launching IHC in a lab in Nigeria.ConclusionsOur program 1) reached hundreds of participants and provided a baseline assessment of pathology capacity across nine SSA countries; 2) created a novel mechanism to build pathology capacity and assess progress with this cohort; and 3) improved practices and the preparation of slides for over half performing manual IHC. After one year, interest was sustained. Tracking impact on diagnosis and treatment of BC in the region is needed long-term.

Quality Improvement and Patient Safety Education in Postgraduate Training Program-A Survey of Residents in Saudi Arabia.

To review the senior resident health trainee's perceived status and need for quality improvement and patient safety (QIPS) education in the residency training program of Saudi Arabia. Residents of medical, dentistry, and pharmacy education were surveyed in 2023 by using pretested 10 QIPS questions. The median and interquartile range (IQR) of the score was correlated to gender, branch, and level of residency training. We surveyed 202 senior residents. Males were 131 (64.9%). Residents of medical (126, 62.4%), dentistry (39, 19.3%), and pharmacy (37, 18.3%). The median score of responses to the QIPS survey was 7.0 (IQR 4.0, 11.6). The median score of residents of dentistry, medicine, and pharmacy were 10 (IQR 7.0, 12.5), 6.75 (IQR 4.0, 12.0), and 5.0 (IQR 2.5, 8.0) respectively, and was significantly different (Kruskal Wallis (KW) chi-square = 19.8, P = .001). The exposure to the QIPS project was significantly and positively associated with a high QIPS score (MW U P = .02). The variations in the score by gender (Mann Whitney P = .148) and the level of residency (KW P = .86) were not statistically significant. Three-fourths of participants feel the need for formal training about QIPS. Nearly half of the participants were not happy with the current method of QIPS training methodology. More than 40% of participants were not sure about questions about opportunities and mentorship of QIPS projects. One-third were involved in QIPS projects. Although senior residents were interested in QIPS, they were dissatisfied with current methods and opportunities to execute supervised QIPS projects. Residents of dentistry and those having performed QIPS projects had higher QPIS knowledge and satisfaction with training.

The Assessment on the Flood Mitigation Strategies of the Local Government Unit of Santo Tomas, Davao del Norte: A Basis for Policy Formulation

This study evaluates flood mitigation strategies implemented by the LGU of Santo Tomas, Davao del Norte, focusing on indicators such as Rehabilitation of River Banks, Bridges, Dredging, and Reforestation. Through random sampling in selected barangays, 377 respondents provided feedback, indicating Very High Descriptive Equivalents for all strategies. However, the detailed analysis identifies the Rehabilitation of River Banks as an area for improvement (mean score: 4.19), emphasizing the need for enhanced catchment drainage, floodwater capacity, and sediment yield reduction. Recommendations include regular maintenance of drainage channels, river widening, and the establishment of riparian buffer zones. Future research should explore flood-prone residents’ perceptions of LGU strategies. A proposed policy on River Bank Rehabilitation emphasizes an ecosystem-based, participatory approach to enhance resilience, increase public awareness, and promote sustainable development. Strategies encompass riparian vegetation restoration, bank stabilization, invasive species control, water quality improvement, floodplain management, and public education. Implementation rests with the LGU of Sto. Tomas and stakeholders, with ongoing monitoring and evaluation to ensure effectiveness and facilitate adjustments. This study provides valuable insights and a practical policy framework to enhance flood mitigation, specifically focusing on river bank rehabilitation in LGU-Santo Tomas, Davao del Norte.

Service Design for Healthcare Quality Improvement: An Implementation Approach for Enhancing Patient Experience

Purpose: This study aims to suggest the future direction for applying service design to improve the quality of healthcare as part of hospital service innovation and present implementation plans in Korea, based on a review of quality improvement activities and the current status of service design applications.Methods: Through a literature review, we examined the status of service design introduction and application in the healthcare field, focusing on cases in the US and Europe. The possibility and limitations of service design in the healthcare field were examined through a comparison of oversea and domestic cases.Results: Recently, service design has begun to be applied to the healthcare field worldwide. Service design shows the possibility of an alternative that alleviates and complements the limitations of existing quality improvement activities. It also offers the possibility of creating new organizational improvement and innovation approaches through integration and convergence with existing quality improvement activities and management innovation.Conclusion: To effectively apply service design to hospitals, it is necessary to integrate internal organizations related to service improvement, combine methods, and objectively measure and evaluate performance. To this end, we propose the operation of a nationwide education and training center for quality improvement and service design led by academic society. Service design will provide an opportunity to change the management innovation and organizational culture of hospitals beyond the scope of the current quality improvement, which deals only with micro-subjects of individual hospitals.

‘안전과 질 향상’ 교과 표준안 개발

Purpose : This study aimed to develop a curriculum standard for “safety and quality improvement” based on the nursing competencies proposed by QSEN(Quality and Safety Education for Nurses). Methods : Through a systematic process involving three stages(analysis-design-development) required for curriculum development, curriculum standards were designed. The Delphi surveys were conducted twice, and through gathering expert opinions, multiple research team meetings were held to refine and crystallize the specific course design into the final standard after several iterations. Results : In this study, 13 modules focusing on the sub factor of safety and quality improvement were developed. Specifically, there are six modules dedicated to safety, two modules each for teamwork &amp; collaboration and quality improvement and one module for each of the remaining three sub factor. Conclusion : The findings of this study represent just a starting point for curriculum development in nursing education for safety and quality improvement. For sustained improvement in safety and quality in clinical practice, nursing educational institutions and clinical facilities must collaborate and work together continuously to evolve in developing nursing education competencies geared towards enhancing safety and quality.

Effects of physician therapy sessions on depression – Evidence-based practices

This research study investigates the impact of physician therapy sessions on individuals suffering from depression. It examines the effectiveness of therapy as an evidence-based practice in the management of depression. Three distinct research papers were reviewed to investigate the effects of therapy sessions on physician burnout. Each study employed various methodologies, including surveys, interventions and qualitative analyses. Gender differences were also examined as a potential variable. Paper one concluded that despite being valuable support mechanisms, debriefing sessions did not significantly reduce burnout syndrome. In contrast, Paper Two and Paper Three reported a significant decrease in burnout following the interventions. All three papers found that gender was the only variable that changed. While the scores of the Maslach Burnout Inventory did not change in Paper One, the debriefing sessions were appreciated and accepted by the participants. Paper Three provided in-depth information, including examples, to enhance comprehension. Two out of the three papers concluded that implementing therapy sessions, such as counselling, cognitive-behavioural therapy, mindfulness-based stress reduction, group therapy, and mindfulness workshops, for physicians can prevent burnout syndrome. The third paper showed no significant change, suggesting that exclusive therapy sessions may need to be combined with other solutions, such as mindfulness practices or reduced working hours. These findings have the potential to inform practice changes, including updated clinical guidelines, new term protocols, enhanced screening and prevention strategies, quality improvement initiatives, training and education feedback, adaptation, monitoring, and evaluation. Overcoming barriers such as knowledge, skills, resources, motivation, attitude, and organisational culture is crucial for the successful implementation of evidence-based practices (EBP). Further, international research is needed to identify local limitations and advantages. This topic offers valuable insights into EBP and its role in improving patient outcomes, with the ultimate goal of reducing physician burnout and enhancing the quality of patient care.

Twelve tips for creating a longitudinal quality improvement and safety education for early health professions students

Despite the numerous calls for integrating quality improvement and patient safety (QIPS) curricula into health professions education, there are limited examples of effective implementation for early learners. Typically, pre-clinical QIPS experiences involve lectures or lessons that are disconnected from the practice of medicine. Consequently, students often prioritize other content they consider more important. As a result, they may enter clinical settings without essential QIPS skills and struggle to incorporate these concepts into their early professional identity formation. In this paper, we present twelve tips aimed at assisting educators in developing QIPS education early in the curricula of health professions students. These tips address various key issues, including aligning incentives, providing longitudinal experiences, incorporating real-world care outcomes, optimizing learning environments, communicating successes, and continually enhancing education and care delivery processes.

How Many Lives Will You Save? A Mixed Methods Evaluation of a Novel, Online Game for Patient Safety and Quality Improvement Education.

Medical trainees have limited knowledge of quality improvement and patient safety concepts. The authors developed a free quality improvement/patient safety educational game entitled Safety Quest (SQ). However, 1803 undergraduate medical trainees, graduate medical trainees, and continuing medical education learners globally completed at least 1 level of SQ. Pre- and post-SQ knowledge and satisfaction were assessed among continuing medical education learners. Thematic analysis of feedback given by trainees was conducted. Among graduate medical trainees, SQ outranked other learning modalities. Three content areas emerged from feedback: engagement, ease of use, and effectiveness; 87% of comments addressing engagement were positive. After completing SQ, 98.6% of learners passed the post-test, versus 59.2% for the pretest (P < 0.0001). Ninety-three percent of learners agreed that SQ was engaging and interactive, and 92% believed it contributed to their professional growth. With an increased need for educational curricula to be delivered virtually, gamification emerges as a unique strategy that learners praise as engaging and effective.

How, and under what contexts, do academic–practice partnerships collaborate to implement healthcare improvement education into preregistration nursing curriculums: a realist review protocol

IntroductionInternationally, healthcare improvement remains a clinical and educational priority. Consensus in Europe, Canada and the USA to implement quality improvement (QI) education into preregistration nursing curricula ensures students become equipped...

The Quality Improvement Fellow: Educating on Making the Difference.

The critical care medicine (CCM) fellowship is an opportunity for advanced anesthesiology trainees to refine their quality improvement (QI) skills. However, the short training period and inconsistent curricula make this challenging. The QI fellow (QIF) is described as an education program to provide consistent QI training during the CCM fellowship. The QIF is a mentored position to help manage data review, QI conferences, and improvement efforts within the CCM Division. The curriculum is focused on a QI education framework and mentored experiential learning. The QIF program is an opportunity for education and mentorship in the role of a CCM operational leader.

Quality Tool School: Improving the Delivery of Quality Improvement Education in a Children's Hospital.

In 2013, Nationwide Children's Hospital's (NCH) Quality Tool School (QTS) was created as an initial Quality Improvement educational series, composed of three separate classes, totaling 5.5 hours of hands-on QI training. QTS complemented the NCH 40-hour Quality Improvement Essentials course. Over 10 years, the series went through three phases of aims: Phase 1: develop and implement three core courses (Project Tools, Excel, and Control Charts); Phase 2: have participants complete the entire series of all three classes; Phase 3: have participants who complete the entire series of all three classes demonstrate the application of learning through involvement in a quality improvement project. Since initiation, QTS has provided an educational entry point for 1428 NCH employees to participate in QI projects and teams. QTS has shown statistically significant improvement in 2 of the 3 principal aims. The Phase 1 metric of average monthly one-class participation completion percentage showed a statistically significant centerline shift from 9 to 16 students in October 2018. The Phase 3 metric Percentage of QTS participants completing the QTS series of classes and then participating in a QI team began in 2016 with a baseline of 42%. A centerline shift from 42% to 63% occurred in Q4 2018. QTS can provide QI education to healthcare system employees using limited resources. Organizations that strategically integrate a culture of QI into core beliefs can realize substantial improvement gains.

Embedding the A-EQUIP model of restorative supervision in a critical care unit by professional nurse advocates.

The professional nurse advocate (PNA) programme was launched in March 2021, which was towards the end of the third wave of COVID-19 and the start of a critical point of recovery. COVID-19 placed exceptional challenges and pressure on healthcare staff, with many experiencing feelings of stress and burnout. The role of the PNA emerged as a response to the impact this had upon the nursing workforce. PNAs are trained to facilitate restorative clinical supervision and to advocate education for quality improvement, resulting in improvements to patient care and staff wellbeing. The programme started with 400 critical care nurses; since then it has been rolled out to all specialties, with the aim to have 5000 PNAs integrated into the national workforce by April 2022. Criteria for the level 7 PNA training programme requires a registered nurse to be working in a patient-facing role, at band 5 or above, hold a level 6 qualification and have approval from their line manager. The training programme is typically 10 to 12 days in length over a 12-week period. This article explores the implementation of the PNA role in a critical care unit.

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.

The 2023 Core Content of advanced emergency medicine ultrasonography

AbstractIn February 2023, the American Board of Emergency Medicine (ABEM) approved modifications to the Advanced Emergency Medicine Ultrasonography (AEMUS) Core Content, which defines the areas of knowledge considered essential for the practice of AEMUS. This manuscript serves as a revision of the AEMUS Core Content originally published in 2014. The revision of the Core Content for AEMUS training aims to establish standardized education and qualifications necessary for AEMUS fellowship program leadership, clinical application, administration, quality improvement, and research. The Core Content provides the organizational framework and serves as the basis for the development of content for the Focused Practice Examination (FPE) administered by ABEM. AEMUS fellowship directors may reference the Core Content when designing AEMUS fellowship curricula to help prepare graduates for the autonomous practice of AEMUS and the FPE. In this article, an updated revision of the previously published AEMUS Core Content is detailed, and the entire development of the Core Content is presented.

Effect of a targeted quality improvement education on opioid prescribing

BackgroundThe opioid epidemic is a serious social, economic and public health problem. This study was designed to evaluate the effectiveness of individual institutional opioid prescriber training on prescriber adherence to...

1033-P: Improving T2D Collaboration and Patient Communication at the Primary Care Level—Findings from Team-Designed Quality Improvement Education Initiative

Background: A system-based Quality Improvement Education intervention (QIEi) was developed to improve disease management for T2D patients with/at-risk of CVD/CKD who may benefit from SGLT-2i/GLP-1RA. The QIEi aimed to improve competencies of PCPs, team collaboration and patient communications. Methods: The QIEi was deployed to PCPs at 2 sites from a USA integrated delivery system. Practice Assessments (PrA) and a pre-intervention EHR data review confirmed the gaps and guided QI team discussions. Team leaders designed webinars on best practices (recorded for later view), and the groups discussed cases, designed process improvements and communication strategies (EHR Smart phrases, clinical reinforcement materials explaining treatments, and enhanced After Visit Summary). Evaluation included PrA (pre=140; post=55), EHR data, smart phrase usage, and qualitative interviews (n=10). Results: PCPs’ comfort discussing treatment with patients increased (Table 1). Interviewees reported an increase in patient interface, confidence educating patients and team engagement. The QIEi led to system-based changes and sustained clinical reinforcement material adoption. Conclusion: A team based QIEi can result in effective design, pilot/adoption of patient materials/EHR tools, supporting patient conversations and fostering informed decisions. Disclosure V.Makin: Speaker's Bureau; Bayer Inc. G.Jacobs: None. B.Dennis frampton: None. K.M.Pantalone: Consultant; AstraZeneca, Bayer Inc., Corcept Therapeutics, Diasome, Eli Lilly and Company, Merck &amp; Co., Inc., Novo Nordisk, Sanofi, Research Support; Bayer Inc., Merck &amp; Co., Inc., Novo Nordisk, Twin Health, Speaker's Bureau; AstraZeneca, Corcept Therapeutics, Merck &amp; Co., Inc., Novo Nordisk. S.Kawczak: None. S.Murray: None. P.Mcfadden: None. P.Rao: None. Funding Eli Lilly and Company; Merck &amp; Co., Inc.