Quality Improvement Knowledge Research Articles

Barriers and facilitators to health professionals' engagement in quality improvement initiatives: a mixed-methods systematic review.

Quality improvement (QI) initiatives in healthcare are crucial for enhancing service quality and healthcare outcomes. The success of these initiatives depends on the active engagement of healthcare professionals, which can be influenced by several factors within the healthcare system. This systematic review synthesized the factors influencing healthcare professionals' engagement in QI projects, focusing on identifying both barriers and facilitators. A mixed methods systematic review (MMSR) was conducted using the JBI methodology for MMSR. Databases such as MEDLINE, CINAHL, Scopus, and Embase were searched for studies that explored barriers and facilitators to QI engagement of health professionals in the clinical setting. Methodological quality was assessed using the Mixed-Methods Appraisal Tool (MMAT). The extracted data were synthesized using the JBI convergent integrated approach to MMSR. Eighteen studies (seven qualitative, nine quantitative, and two mixed-methods) published between 2007 and 2023 were included in the review. The analysis revealed barriers and facilitators to engagement in QI initiatives at different levels of the health system. At the QI program level, the engagement of health professionals to QI was influenced by the approach to QI, evidence underpinning the QI initiative, QI knowledge and training, and access to QI specialists. At the health professional level, barriers and facilitators were related to their organizational role, motivation, perceptions about QI, and collaborations with individuals and groups. At the organizational level, factors related to culture and climate, leadership, available resources (including human resource and workload, infrastructure, and incentives), and institutional priorities influenced health professionals' participation in QI. This review highlights the complex interplay of organizational, individual, and QI program level factors that influence the engagement of healthcare professionals in QI. Overcoming these complex barriers and leveraging facilitators is crucial for enhancing participation in QI efforts. The findings underscore the need for a multi-level strategy that focuses on creating a conducive organizational culture, providing robust leadership, and ensuring adequate resources and training for healthcare professionals. Such strategies hold the potential to enhance the effectiveness and sustainability of QI initiatives in healthcare settings.

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 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.

A pilot initiative to enhance quality improvement teaching with simulation.

Quality Improvement and Patient Safety (QIPS) is a recognised competency across residency programmes. Although a variety of teaching modalities exist, many do not represent the multifaceted clinical environment that trainees work in. Residents have reported challenges in linking QIPS classroom-based learning with their clinical duties. High-fidelity simulation has been used to bridge this gap within clinical skills teaching and therefore has potential to address this issue in QIPS learning. We developed and piloted four high-fidelity simulation scenarios with 15 surgical residents (Orthopaedics, General Surgery, Gynaecology and Neurosurgery). Each scenario contained elements of both latent and active safety errors. Residents were provided with a short pre-reading from an open-access resource on basic QIPS methodology and underwent a debriefing by a trained QIPS faculty. Residents were then tasked to apply their learning to their scenario to develop a QIPS-focused solution. Objective knowledge acquisition was assessed with the Quality Improvement Knowledge Assessment Tool-Revised (QIKAT-R) in conjunction with a survey based upon the Kirkpatrick Model of Learning. Overall, residents agreed that the simulation was helpful in learning QIPS methodology and agreed that they could perform fundamental QIPS tasks. The average QIKAT-R score demonstrated a trend towards improvement. High-fidelity simulation is a potential means to provide residents with hands-on experience in QIPS knowledge acquisition and application. Future directions should aim to compare the efficacy of simulation with other teaching modalities and evaluate the long-term impact of QIPS teaching on resident behaviours and motivation to take part in QIPS initiatives.

Emergency Department Buprenorphine Quality Improvement and Emergency Physician Knowledge, Attitudes, and Self-Efficacy.

Buprenorphine is an evidence-based treatment for opioid use disorder that is underused in the emergency department (ED). In this study we evaluated changes in emergency physician knowledge, confidence, and self-efficacy regarding buprenorphine prescribing and working with patients who use drugs after implementation of an ED buprenorphine quality improvement (QI) initiative. An anonymous, online survey was administered to emergency physicians staffing four EDs in New England in 2019 and 2020 before and after an ED QI initiative. Survey questions included novel and previously validated questions to assess confidence, knowledge, self-efficacy, and attitudes about buprenorphine and working with patients who use drugs. Confidence, self-efficacy, and attitude responses were assessed on a Likert scale. Participants received a gift card for survey completion. We analyzed pre- and post- survey responses descriptively and compared them using t-tests. Using logistic regression we evaluated the factors associated with buprenorphine prescribing. Of 95 emergency physicians, 56 (58.9% response rate) completed the pre-intervention survey and 60 (63.2%) completed the post-survey. There was an increase in the number of X-waivered adult emergency physicians and ED buprenorphine prescribing after program implementation. Physician confidence increased from a mean of 3.4 (SD 0.8) to 3.9 (SD 0.7; scale 1-5, p < 0.01). Knowledge about buprenorphine increased from a mean score of 1.4 (SD 0.7) to 1.7 (SD 0.5, p < 0.01). Physician attitudes and self-efficacy did not change. Post-initiative, increased confidence was associated with higher odds of buprenorphine prescribing (odds ratio 4.4; 95% confidence interval 1.07-18.4). After an ED QI initiative, buprenorphine prescribing in the ED increased, as did both physician confidence in working with patients who use drugs and their knowledge of buprenorphine. Increased confidence was associated with higher odds of buprenorphine prescribing and should be a focus of future, buprenorphine implementation strategies in the ED.

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.

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.

Design and Evaluation of an Interprofessional Preceptor Development Mini-Fellowship Program.

Health professions preceptors require skills and knowledge to effectively meet the educational needs of interprofessional students in clinical environments. We implemented a mini-fellowship program to enhance the knowledge, skills, and self-efficacy of preceptors teaching students and applying quality improvement (QI) methods across disciplines and patient care settings. The design, implementation, and evaluation of the program were informed by the faculty development literature, principles of adult learning, and preceptor needs. The 3-day program included workshops on curriculum design, clinical teaching methods, QI, social determinants of health, cultural humility, and interprofessional teamwork. Quantitative and qualitative evaluation methods were used including preprogram and postprogram knowledge and self-efficacy surveys, along with end-of-session and program evaluations. Five annual cohorts involving 41 preceptors with varied demographics, professions, and clinical practices completed the mini-fellowship program. Participants' percentage of items answered correctly on a QI knowledge test increased from 79.2% (pretest) to 85.5% (post-test), a gain of 6.3% (90% CI: 2.9-9.7%; P < .003). The average QI self-efficacy scores improved from 2.64 to 3.82, a gain of 1.18 points on a five-point scale (P < .001). The average education/teaching self-efficacy increased from 2.79 to 3.80 on a five-point scale (P < .001). Ultimately, 94% would recommend the program to other preceptors. An interprofessional preceptor development program designed to train clinicians to effectively teach in the clinical setting and to conduct QI projects with students was achievable and effective. This program can serve as a model for academic centers charged with training future health care workers and supporting their community-based preceptors' training needs.

Teaching quality improvement concepts to pharmacy students using the Evidence-based Practice for Improving Quality (EPIQ) workshop

Background and purposeDespite the benefits of quality improvement (QI) training, there is a scarcity of information on QI teaching formats for undergraduate pharmacy education. The Evidence-based Practice for Improving Quality (EPIQ) workshop was evaluated as a teaching format for a group of multi-year undergraduate pharmacy students, assessing knowledge acquisition and learner reactions. Educational activity and settingUsing a convergent mixed-method analysis, 10-item pre- and post-workshop multiple-choice questionnaires measured students' knowledge acquisition of foundational QI concepts. A six-item pre- and post-workshop survey and a voluntary post-workshop focus group evaluated students' attitudes towards QI training and the teaching format. Mann-Whitney U non-parametric test was used to analyze the quantitative data, while thematic analysis was applied to analyze the qualitative data. FindingsTwenty-nine pharmacy students participated in the workshop. There was a statistically significant improvement in pharmacy students’ QI knowledge before and after participating in the workshop (77% vs. 86%, P = .008). The evaluation of the EPIQ teaching format resulted in three important findings: (1) undergraduate pharmacy students identified a QI learning need; (2) the EPIQ workshop effectively provided foundational QI literacy for all pharmacy student years using a “learning by sharing” methodology and pharmacy-specific case studies; and (3) interested students may benefit from an experiential elective to apply QI techniques. SummaryThe perceived value of QI training for pharmacy students using the EPIQ workshop was demonstrated: students expressed an interest in lifelong learning and a desire to pursue QI projects at school, during a clinical rotation, or at work.

‘The objective was about not blaming one another’: a qualitative study to explore how collaboration is experienced within quality improvement collaboratives in Ethiopia

BackgroundQuality improvement collaboratives are a common approach to improving quality of care. They rely on collaboration across and within health facilities to enable and accelerate quality improvement. Originating in high-income settings, little is known about how collaboration transfers to low-income settings, despite the widespread use of these collaboratives.MethodWe explored collaboration within quality improvement collaboratives in Ethiopia through 42 in-depth interviews with staff of two hospitals and four health centers and three with quality improvement mentors. Data were analysed thematically using a deductive and inductive approach.ResultsThere was collaboration at learning sessions though experience sharing, co-learning and peer pressure. Respondents were used to a blaming environment, which they contrasted to the open and non-blaming environment at the learning sessions. Respondents formed new relationships that led to across facility practical support. Within facilities, those in the quality improvement team continued to collaborate through the plan-do-study-act cycles, although this required high engagement and support from mentors. Few staff were able to attend learning sessions and within facility transfer of quality improvement knowledge was rare. This affected broader participation and led to some resentment and resistance. Improved teamwork skills and behaviors occurred at individual rather than facility or systems level, with implications for sustainability. Challenges to collaboration included unequal participation, lack of knowledge transfer, high workloads, staff turnover and a culture of dependency.ConclusionWe conclude that collaboration can occur and is valued within a traditionally hierarchical system, but may require explicit support at learning sessions and by mentors. More emphasis is needed on ensuring quality improvement knowledge transfer, buy-in and system level change. This could include a modified collaborative design to provide facility-level support for spread.

Abstract 1: A Learning Collaborative Model to Empower Rural Rwandan Health Centers to Improve the Quality of Screening for Women’s Cancers

Abstract Purpose: Screening and early detection initiatives for breast and cervical cancer are public health priorities in sub-Saharan Africa, but sustainable strategies to monitor screening quality in rural health facilities are not well-described. We sought to empower rural primary care clinicians to monitor and improve screening quality and integrate quality improvement (QI) into routine practice through a learning collaborative in 8 health facilities participating in a breast and cervical cancer screening initiative in Burera district, Rwanda. We evaluated the model’s impact on participant knowledge/attitudes and QI projects’ success. Methods: Two-day didactic sessions in March 2022 addressed quality measurement and QI implementation. QI knowledge/attitudes were assessed before and after training using a brief written survey and compared using paired t-tests. Participants (all nurses) then identified a cancer screening problem at their health facility that could be solved using QI methods and planned projects. All health center (HC) trainees focused on increasing the proportion of eligible women screened for cervical cancer in their sectors, via educational campaigns. District hospital (DH) team members aimed to reduce missed referral visits. At subsequent meetings, teams discussed projects and next steps. Results: Three clinicians from each of 7 HCs and 2 from the DH (n=23) participated in training; 22 took pre- and post-training surveys. Baseline mean knowledge scores (66.5%,SD 11.8) improved following training (82.4%,SD 12.0,p&amp;lt;0.001). After training, 22(100%) reported interest in being more engaged in QI. In the 6 months following project implementation, HCs saw a 4.8-fold increase in the mean number of patients screened across 7 HCs (35.4,SD 17.1) compared to 6 months prior (7.5,SD 2.6). Efforts to reduce missed visits could not be assessed due to inability of the cancer screening electronic medical record to track patients across facilities. Conclusion: A learning collaborative model engaged rural primary care clinicians in evaluating and improving cancer screening practices. QI knowledge improved and HCs met initial project goals. Though projects focused on patient volume, future initiatives should examine other critical quality measures i.e., referral completion and time to cancer diagnosis. Improving data collection systems is essential to facilitate availability of follow-up data and patient tracking and empower clinicians to monitor care quality. Citation Format: Jean-Marie Vianney Dusengimana, Jean de Dieu Uwihaye, Amanda Fata, David Tuyisenge, Aphrodis Ndayisaba, Vestine Rugema, Marie Louise Uwineza, Lawrence N. Shulman, Cyprien Shyirambere, Lydia E. Pace. A Learning Collaborative Model to Empower Rural Rwandan Health Centers to Improve the Quality of Screening for Women’s Cancers [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 1.

“Quality teaches you how to use water. It doesn’t provide a water pump”: a qualitative study of context and mechanisms of action in an Ethiopian quality improvement program

BackgroundQuality improvement collaboratives are a common approach to bridging the quality-of-care gap, but little is known about implementation in low-income settings. Implementers rarely consider mechanisms of change or the role of context, which may explain collaboratives’ varied impacts.MethodsTo understand mechanisms and contextual influences we conducted 55 in-depth interviews with staff from four health centres and two hospitals involved in quality improvement collaboratives in Ethiopia. We also generated control charts for selected indicators to explore any impacts of the collaboratives.ResultsThe cross facility learning sessions increased the prominence and focus on quality, allowed learning from experts and peers and were motivational through public recognition of success or a desire to emulate peers. Within facilities, new structures and processes were created. These were fragile and sometimes alienating to those outside the improvement team. The trusted and respected mentors were important for support, motivation and accountability. Where mentor visits were infrequent or mentors less skilled, team function was impacted. These mechanisms were more prominent, and quality improvement more functional, in facilities with strong leadership and pre-existing good teamwork; as staff had shared goals, an active approach to problems and were more willing and able to be flexible to implement change ideas. Quality improvement structures and processes were more likely to be internally driven and knowledge transferred to other staff in these facilities, which reduced the impact of staff turnover and increased buy-in. In facilities which lacked essential inputs, staff struggled to see how the collaborative could meaningfully improve quality and were less likely to have functioning quality improvement. The unexpected civil unrest in one region strongly disrupted the health system and the collaborative. These contextual issues were fluid, with multiple interactions and linkages.ConclusionsThe study confirms the need to carefully consider context in the implementation of quality improvement collaboratives. Facilities that implement quality improvement successfully may be those that already have characteristics that foster quality. Quality improvement may be alienating to those outside of the improvement team and implementers should not assume the organic spread or transfer of quality improvement knowledge.

Building Resident Quality Improvement Knowledge and Engagement Through a Longitudinal, Mentored, and Experiential Learning-Based Quality Improvement Curriculum.

Quality improvement (QI) training is an essential component of resident medical education and a part of the ACGME core competencies. We present our residency's evidence-based QI curriculum, which outlines key components identified in the literature for successful QI education. Our curriculum included a mandatory five-part longitudinal educational series during ambulatory education sessions for second-year residents. Modeled after the Institute for Healthcare Improvement model for improvement and taught by a chief resident, our curriculum introduced residents to key QI concepts through case-based, just-in-time didactics and applied experiential learning via concurrent resident-led longitudinal QI projects. Residents received structured, multilayer mentorship from a faculty mentor in their field of interest and the chief resident of quality and patient safety. Their work-in-progress projects were presented to faculty QI experts and institutional leadership for additional feedback and mentorship. Since 2016, a total of 234 internal medicine residents have completed our QI curriculum and developed 67 QI projects, which have been presented at various local, regional, and national conferences. In the 2 most recent academic years, Quality Improvement Knowledge Application Tool Revised (QIKAT-R) scores significantly increased from 4.6 precurriculum to 6.3 postcurriculum (p < .001). A longitudinal, experiential, and mentored QI curriculum teaches residents QI skill sets through incorporating mechanisms associated with successful educational initiatives and adult learning theory. Our QIKAT-R results and project output show that our curriculum is associated with improved trainee QI knowledge and systems-level improvements.

Implementation Science for the Practice-Oriented Nurse Leader.

Senior nurse leaders are accountable for improving patient outcomes efficiently and cost-effectively. Nurse leaders often find heterogeneous patient outcomes across comparable nursing units in the same enterprise, presenting a challenge for nurse leaders tasked with making system-wide quality improvements. Implementation science (IS) offers a promising new approach to guide nurse leaders in understanding why certain implementation efforts meet with success or failure and the barriers faced in making practice changes. Knowledge of IS builds upon evidenced-based practice and quality improvement knowledge, adding to the armamentarium of tools at nurse leaders' disposal for improving nursing and patient outcomes. In this article, we demystify IS, differentiate it from evidence-based practice and quality improvement, describe IS concepts every nurse leader should be familiar with, and outline nurse leaders' role in building IS in their organizations.

Outcomes in quality improvement and patient safety training: moving from in-person to synchronous distance education

BackgroundThe COVID-19 pandemic necessitated increased synchronous distance education (SDE) in graduate medical education, presenting challenges for Quality Improvement and Patient Safety (QIPS) best practices, which call for integration with daily...

Implementation and evaluation of an elective quality improvement curriculum for preclinical students: a prospective controlled study

BackgroundQuality improvement (QI) is a systematic approach to improving healthcare delivery with applications across all fields of medicine. However, exposure to QI is minimal in early medical education. We evaluated the effectiveness of an elective QI curriculum in teaching preclinical health professional students foundational QI concepts.MethodsThis prospective controlled cohort study was conducted at a single academic institution. The elective QI curriculum consisted of web-based video didactics and exercises, supplemented with in-person classroom discussions. An optional hospital-based QI project was offered. Assessments included pre- and post-intervention surveys evaluating QI skills and beliefs and attitudes, quizzes, and Quality Improvement Knowledge Application Tool-Revised (QIKAT-R) cases. Within-group pre-post and between-group comparisons were performed using descriptive statistics.ResultsOverall, 57 preclinical medical or physician assistant students participated under the QI curriculum group (N = 27) or control group (N = 30). Twenty-three (85%) curriculum students completed a QI project. Mean quiz scores were significantly improved in the curriculum group from pre- to post-assessment (Quiz 1: 2.0, P < 0.001; Quiz 2: 1.7, P = 0.002), and the mean differences significantly differed from those in the control group (Quiz 1: P < 0.001; Quiz 2: P = 0.010). QIKAT-R scores also significantly differed among the curriculum group versus controls (P = 0.012). In the curriculum group, students had improvements in their confidence with all 10 QI skills assessed, including 8 that were significantly improved from pre- to post-assessment, and 4 with significant between-group differences compared with controls. Students in both groups agreed that their medical education would be incomplete without a QI component and that they are likely to be involved in QI projects throughout their medical training and practice.ConclusionsThe elective QI curriculum was effective in guiding preclinical students to develop their QI knowledge base and skillset. Preclinical students value QI as an integral component of their medical training. Future directions involve evaluating the impact of this curriculum on clinical clerkship performance and across other academic institutions.

A study to assess the knowledge of Nabh accreditation standards and quality improvement among intensive care unit staff nurses

A study to assess the knowledge of Nabh accreditation standards and quality improvement among intensive care unit staff nurses

A Scoring Rubric for the Knowledge Section of the Systems Quality Improvement Training and Assessment Tool.

Quality improvement (QI) competencies for health professions trainees were developed to address health care quality. Strategies to integrate QI into curricula exist, but methods for assessing interdisciplinary learners' competency are less developed. We refined the Knowledge section scoring rubric of the Systems Quality Improvement Training and Assessment Tool (SQI TAT) and examined its validity evidence. In 2017, the SQI TAT Knowledge section was expanded to cover seven core QI concepts, and the scoring rubric was refined. Three coders independently scored 35 SQI TAT Knowledge sections (18 pretests, 17 posttests). Interrater reliability was assessed by percent agreement and Cohen's kappa for individual variables and by Lin's concordance correlation for total scores for knowledge and application. Concurrent validity was assessed by comparing responses from two groups with different QI exposure and evaluating whether differences in exposure were measured. Total-score interrater reliability average measures of concordance were .89 for all coders and >.70 for six of seven concept scores. The total score discriminated the two groups (p <. 05), and five of seven concept scores were higher for the group with more QI experience. Total scores were significantly higher posttest than pretest (p < .001), with improvement in posttest knowledge scores. The SQI TAT Knowledge section provides a comprehensive assessment of QI knowledge. The scoring rubric was able to discriminate QI knowledge along a continuum. The SQI TAT Knowledge section is not linked to a clinical context, making it useful for assessing interprofessional learners and varying education levels.

Examining QI Knowledge Among Frontline Nurses and Nurse Leaders.

Frontline nurses deliver direct patient care and by participating in quality improvement (QI) can have an impact on health care quality and safety. Unfortunately, nurses are not participating in QI, which may be due to a lack of QI knowledge. The purpose of this study was to evaluate nurses QI knowledge utilizing the revised Quality Improvement Knowledge Application Tool (QIKAT-R), with newly created nursing scenarios, among frontline nurses and nurse leaders. Using a cross-sectional design, this study evaluated nurses QI knowledge utilizing the QIKAT-R. Overall, QI knowledge among nurses was low. The frontline nurses (n = 44) scored higher than nurse leaders (n = 11) on overall QI knowledge scores, although not significant. Frontline nurses scored higher in QI knowledge related to aim and measure, whereas nurse leaders scored higher in change. Understanding frontline nurses QI knowledge, such as with the QIKAT-R with newly created nursing scenarios, can assist with creating targeted strategies for improving overall engagement in QI.