Quality Improvement Training Program Research Articles

Performance of Islamic Teachers in Madrasah: Analysis of Problems and Solutions in the Learning Process

This study investigates the performance achievements of 60 Islamic teachers in madrasahs during the learning process and identifies the problems and solutions needed to ensure all teachers meet the standards set by the Decree of the Minister of Education, Culture, Research, and Technology of the Republic of Indonesia Number 209//P/2021. Utilizing a survey methodology and in-depth interviews, the study found several challenges: 19 teachers struggled with implementing contextual learning; 8 teachers faced issues with process and results assessment; 18 teachers had problems with remedial and enrichment programs; 15 teachers found it difficult to create a pleasant learning environment; 31 teachers encountered obstacles in promoting reading and writing literacy; 10 teachers had trouble ensuring student safety, comfort, and cleanliness; and 17 teachers faced difficulties optimizing school facilities and infrastructure. These challenges were attributed to the lack of active participation in teacher quality improvement training programs such as contextual teaching and learning, assessment instruments, active learning, literacy, and media and learning resource development training. Interviews with teachers who did not face these difficulties indicated that their participation in ongoing professional development programs helped them overcome these issues. Consequently, it is recommended that school stakeholders support teachers' involvement in these professional development programs to enhance their performance.

The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative: A Novel Quality Improvement Training Program for Undergraduate and Postgraduate Students.

The Healthcare Improvement and Innovation in Quality (THINQ) Collaborative is a uniquely designed program that engages undergraduate and postgraduate students to participate in improving health care and addressing important clinical problems. In 9 years, over 120 THINQ Fellows have been trained in quality improvement (QI) frameworks and methodologies focusing on research skills, social justice, leadership development, and problem-solving. Program evaluation has included surveying current and former THINQ Fellows about their experiences with the program and its subsequent impact on their careers. THINQ's research and outreach initiatives have contributed to improvements in workflows and clinical care on topics such as interdisciplinary team communication, discharge and care transition, sepsis management, and physician burnout. The THINQ Program has equipped future health care leaders to engage with and address QI issues in clinical practice. The structures, processes, and outcomes discussed here can guide other institutions in creating similar QI programs.

Catalyzing System Change: 100 Quality Improvement Projects in 1000 Days.

Health system change requires quality improvement (QI) infrastructure that supports frontline staff implementing sustainable innovations. We created an 8-week rapid-cycle QI training program, Stanford Primary Care-Project Engagement Platform (PC-PEP), open to patient-facing primary care clinicians and staff. Examine the feasibility and outcomes of a scalable QI program for busy practicing providers and staff in an academic medical center. Program evaluation. A total of 172 PCPH team members: providers (n = 55), staff (n = 99), and medical learners (n = 18) in the Stanford Division of Primary Care and Population Health (PCPH) clinics, 2018-2021. We categorized projects by the Institute for Healthcare Improvement's (IHI) Quintuple Aim (QA): better health, better patient experience, lower cost of care, better care team experience, and improved equity/inclusion. We assessed project progress with a modified version of The Ottawa Hospital Innovation Framework: step 1 (identified root causes), step 2 (designed/tested interventions), step 3 (assessed project outcome), step 4 (met project goal with target group), step 5A (intervention(s) spread within clinic), step 5B (intervention(s) spread to different setting). Participants rated post-participation QI self-efficacy. Within 1000days, 172 unique participants completed 104 PC-PEP projects. Most projects aimed to improve patient health (55%) or care team experience (23%). Among projects, 9% reached step 1, 8% step 2, 16% step 3, 26% step 4, 21% step 5A, and 20% step 5B. Learner involvement increased likelihood of scholarly products (47% vs 10%). Forty-six of 47 (98%) survey respondents reported improved QI self-efficacy. Medical assistants, more so than physicians, reported feeling acknowledged by the health system for their QI efforts (100% vs 61%). With appropriate QI infrastructure, scalable QI training models like Stanford PC-PEP can empower frontline workers to create meaningful changes across the IHI QA.

Update of ongoing organizational partnership expanding ASCO Quality Training Program to oncology pharmacists.

377 Background: Pharmacists have a recognized role in optimizing medication management and enhancing patient quality of care. The Hematology/Oncology Pharmacy Association (HOPA) partnered with American Society of Clinical Oncology (ASCO) Quality Training Program (QTP) to provide 1-day HOPA sponsored HOPA-ASCO QTP Workshops for HOPA members to enhance knowledge and skills related to oncology quality improvement (QI). The Workshop has been given annually from 2019-2022. Methods: The 1-day Workshop is a condensed overview of foundational quality improvement principles and methodologies consistent with ASCO’s QTP 6-month curriculum. These Workshops were tailored for HOPA members with examples specific to challenges routinely met by oncology pharmacists and leveraged prior HOPA-workshop participants to moderate breakout sessions. Surveys were formulated to assess knowledge pre- and post-participation as well as actionable efforts participants made given knowledge gained from the workshop. Results: A total of 124 HOPA members from 83 different oncology institutions have participated in the four workshops. With a 83% post-participation survey response rate, measures of knowledge and competency increased after participation. Knowledge increased an average of 3.3 points from 3.99 to 7.31 (1-10 scale) and competence increased an average of 3.1 points from 3.82 to 6.91. Ninety-nine percent of respondents were extremely or very likely to recommend someone to participate in the workshop, and 99% were extremely or very likely to continue using the skills gained in their practice. In the 3-month follow-up survey (41% response rate), 84% of respondents indicated they used the skills gained from the program somewhat, very or extremely often and 80% had or were planning to develop a QI project. Top reasons for participation were: content focused on cancer care, ASCO’s reputation, and the comprehensive training in the science of quality improvement. Seven participants completed the ASCO QTP 6-month course after participating in the Workshop. Conclusions: Consistent positive feedback from participants and aligned organizational priorities in improving the quality of care of cancer patients facilitates this continued organizational collaboration. Future workshops will consider feedback from participants to optimize the learning environment and program outcomes. This Workshop is the only quality improvement training program focused specifically on oncology pharmacists providing excellent training and education to HOPA members.

Building infrastructure to teach quality improvement

With growing emphasis on healthcare quality improvement (QI) at both national and local levels, there has been increased demand for instructional programs to teach quality improvement as a discipline. Design of QI teaching programs must take into account local resources as well as the background and competing commitments of the learner. In this article, we review elements of successful quality improvement training programs including structure of didactic and experiential curricula. Special considerations for training programs at the undergraduate and graduate medical, hospital, and national/professional society level are presented.

Understanding the State of Quality Improvement Education for Pediatric Infectious Diseases Trainees.

To the editor, Quality Improvement (QI) training and experience are mandated by the Accreditation Council for Graduate Medical Education for all physician trainees [1], but descriptions of QI training programs for subspecialty fellows are limited [2]. While relevant for all specialties, these skills are particularly useful in infectious diseases. For example, the Infectious Diseases Society of America (IDSA) emphasizes QI concepts such as process and outcome measures in antimicrobial stewardship [3]. To our knowledge, no publications describe the current state of QI education for pediatric infectious disease (PID) trainees. To better understand the current landscape and gauge interest in a potential QI training curriculum that could be offered through the Pediatric Infectious Diseases Society (PIDS), we surveyed PID program directors (PDs) in November 2022 through the official PIDS listserv. Question domains included high-level program demographics, local QI training opportunities, expectations around QI work products, and interest in a national curriculum. The survey was built in a secure REDCap (Research Electronic Data Capture, Vanderbilt, TN) [4] database. No identifying information was captured. This study was deemed exempt from full review by our local Institutional Review Board.

The ACR Learning Network: Facilitating Local Performance Improvement Through Shared Learning

PurposeThe ACR Learning Network was established to test the viability of the learning network model in radiology. In this report, the authors review the learning network concept, introduce the ACR Learning Network and its components, and report progress to date and plans for the future. MethodsPatterned after institutional programs developed by the principal investigator, the ACR Learning Network was composed of four distinct improvement collaboratives. Initial participating sites were solicited through broad program advertisement. Candidate programs were selected on the basis of assessments of local leadership support, experience with quality improvement initiatives, intraorganizational relationships, and access to data and analytic support. Participation began with completing a 27-week formal quality improvement training and project support program, with local teams reporting weekly progress on a common performance measure. ResultsFour improvement collaborative topics were chosen for the initial cohort with the following numbers of participating sites: mammography positioning (6), prostate MR image quality (6), lung cancer screening (6), and follow-up on recommendations for management of incidental findings (4). To date, all sites have remained actively engaged and have progressed in an expected fashion. A detailed report of the results of the improvement phase will be provided in a future publication. ConclusionsTo date, the ACR Learning Network has successfully achieved planned milestones outlined in the program’s plan, with preparation under way for the second and third cohorts. By providing a shared platform for improvement training and knowledge sharing, the authors are optimistic that the network may facilitate widespread performance improvement in radiology on a number of topics for years to come.

Formative Evaluation of a Workforce Investment Organization to Provide Scaled Training for Home Health Aides Serving Managed Long-Term Care Plan Clients in New York State

As part of its Medicaid program restructuring, New York State funded 11 Workforce Investment Organizations (WIO) to support training initiatives for the long-term care workforce. Focusing on one WIO, this formative evaluation examined quality improvement training programs delivered to 11,163 Home Health Aides employed by home care agencies serving clients of Managed Long-Term Care plans. Results are presented from a thematic analysis of qualitative interviews with organizational and program stakeholders examining contextual factors influencing program objectives, implementation, barriers and facilitators, and perceived outcomes. Findings suggested that WIO training programs were implemented during a period of shifting organizational strategies alongside value-based payment reforms and challenges to aide recruitment and retention. Stakeholders appraised WIO training programs positively and valued program flexibility and facilitation of communication and collaboration between agencies and plans. However, delivery and implementation challenges existed, and industry-wide structural fragmentation led stakeholders to question the WIO's larger impact.

Evaluation of a virtual quality improvement training programme

Background/Aims The COVID-19 pandemic challenged not only global healthcare systems, but also educational systems, with many large, in-person training programmes being suspended. Instead, virtual learning platforms have been used, with promising results. This study explored the effectiveness of a virtual quality improvement training programme in a healthcare setting. Methods A 6-week interprofessional virtual quality improvement training programme was developed and delivered to a total of 137 participants across three cohorts. Pre- and post-programme surveys were administered to assess knowledge gained from training. Focus groups were also conducted for more in-depth feedback about the sessions. Information was then collected regarding any quality improvement projects participants had undertaken after completing the training. Results Mean scores were higher in the post-programme than the pre-programme survey across all knowledge domains (P<0.001, Cohens d=6.63). Over 80% of participants reported that the training improved their understanding of and confidence in undertaking a quality improvement project, and that they would recommend the training to their colleagues. Participants went on to either lead or contribute to a variety of quality improvement projects across a wide range of specialisms. Conclusions The virtual quality improvement training programme is an effective method of teaching, leading to participants being able to demonstrate competency in quality improvement. This approach to training delivery represents an efficient alternative to in-person training for building capability in frontline healthcare staff.

Implementation of a Web-Based Tool for Shared Decision-making in Lung Cancer Screening: Mixed Methods Quality Improvement Evaluation.

BackgroundLung cancer risk and life expectancy vary substantially across patients eligible for low-dose computed tomography lung cancer screening (LCS), which has important consequences for optimizing LCS decisions for different patients. To account for this heterogeneity during decision-making, web-based decision support tools are needed to enable quick calculations and streamline the process of obtaining individualized information that more accurately informs patient-clinician LCS discussions. We created DecisionPrecision, a clinician-facing web-based decision support tool, to help tailor the LCS discussion to a patient’s individualized lung cancer risk and estimated net benefit.ObjectiveThe objective of our study is to test two strategies for implementing DecisionPrecision in primary care at eight Veterans Affairs medical centers: a quality improvement (QI) training approach and academic detailing (AD).MethodsPhase 1 comprised a multisite, cluster randomized trial comparing the effectiveness of standard implementation (adding a link to DecisionPrecision in the electronic health record vs standard implementation plus the Learn, Engage, Act, and Process [LEAP] QI training program). The primary outcome measure was the use of DecisionPrecision at each site before versus after LEAP QI training. The second phase of the study examined the potential effectiveness of AD as an implementation strategy for DecisionPrecision at all 8 medical centers. Outcomes were assessed by comparing absolute tool use before and after AD visits and conducting semistructured interviews with a subset of primary care physicians (PCPs) following the AD visits.ResultsPhase 1 findings showed that sites that participated in the LEAP QI training program used DecisionPrecision significantly more often than the standard implementation sites (tool used 190.3, SD 174.8 times on average over 6 months at LEAP sites vs 3.5 SD 3.7 at standard sites; P<.001). However, this finding was confounded by the lack of screening coordinators at standard implementation sites. In phase 2, there was no difference in the 6-month tool use between before and after AD (95% CI −5.06 to 6.40; P=.82). Follow-up interviews with PCPs indicated that the AD strategy increased provider awareness and appreciation for the benefits of the tool. However, other priorities and limited time prevented PCPs from using them during routine clinical visits.ConclusionsThe phase 1 findings did not provide conclusive evidence of the benefit of a QI training approach for implementing a decision support tool for LCS among PCPs. In addition, phase 2 findings showed that our light-touch, single-visit AD strategy did not increase tool use. To enable tool use by PCPs, prediction-based tools must be fully automated and integrated into electronic health records, thereby helping providers personalize LCS discussions among their many competing demands. PCPs also need more time to engage in shared decision-making discussions with their patients.Trial RegistrationClinicalTrials.gov NCT02765412; https://clinicaltrials.gov/ct2/show/NCT02765412

Editors’ Note and Prologue

Editors’ Note and Prologue

Evaluation of the Impact of an Education Program on Self-Reported Leadership and Management Competence Among Nurse Managers.

BackgroundDeveloping leadership and management competencies for nursing managers is critical to the effective leadership of others and driving team and organizational performance. This paper aimed to evaluate the impact of a system-wide nursing leadership quality improvement initiative in a network of four public hospitals and one specialized outpatient center in the United Arab Emirates (UAE). The initiative was designed to enhance nursing middle managers’ leadership and managerial competencies.MethodsThis is a quantitative evaluation following the Standards for Quality Improvement Reporting Excellence (SQUIRES) guidelines. Secondary Data analysis of a pre- and post-course self-assessment for 105 middle nursing managers who attended a nursing leadership quality improvement training program between December 2017 and April 2019.ResultsFollowing participation in this quality improvement initiative, the paired sample t-test analysis demonstrated a statistically significant difference between the pre- and post-assessments total and individual leadership domains mean scores.ConclusionAttending well-structured nursing leadership quality improvement programs positively enhances nurse managers’ professional abilities and perception of their management and leadership competencies. Leadership development programs should equip managers with the skills and tools to achieve their professional goals effectively and support their transition to becoming expert nurse leaders. Healthcare institutions’ ethical obligation is to provide them with the necessary resources and training to achieve this goal.

Implementation and Effects of a Team-Based Quality Improvement Training Program Across a Health System: The Northwestern Medicine Academy for Quality and Safety Improvement

Professional organizations emphasize the need to train health care professionals in quality improvement (QI). Many reports of QI education programs involve small numbers of participants. Little is known about QI education programs on a larger scale and whether participants subsequently engage in QI activities. The Northwestern Medicine Academy for Quality and Safety Improvement (NM AQSI) was developed to prepare individuals across the Northwestern health system to lead QI. The 7-month program consists of classwork and team-based project work. Participant knowledge was assessed using a multiple-choice test and adapted Quality Improvement Knowledge Application Tool (QIKAT). The study team surveyed participants 18 months after AQSI completion to assess their activity in QI. Project status was assessed at AQSI completion and at 18 months. Over 8 years, 80 teams consisting of 441 individuals participated, representing a range of specialties, settings, and professions. Participants had higher multiple-choice test (70.7 ± 14.0 vs. 78.1 ± 13.0; p < 0.001) and adapted QIKAT scores (56.1 ± 15.9 vs. 60.8 ± 15.8; p < 0.001) after AQSI. The majority of participants at 18 months (180/243; 74.1%) had engaged in subsequent QI efforts; many (105/243; 43.2%) had led other QI projects, and (103/243; 42.4%) provided QI mentorship to others. The majority of teams (53/80; 66.3%) improved project measure performance. NM AQSI is a team-based QI training program that shows measurable improvements in care and a high degree of participants' subsequent involvement in QI. Other health systems may use a similar approach to successfully train health care professionals to lead QI.

Abstract 49: Building a Culture of Quality Improvement at Butaro Cancer Center of Excellence in Rwanda

Abstract Purpose: As access to cancer care expands in sub-Saharan Africa, it is essential to develop strategies to examine and improve cancer care quality. We designed and implemented a quality improvement (QI) training and mentorship program for clinicians at Butaro Cancer Center of Excellence (BCCOE) in Rwanda to foster a culture of continual improvement. We report our early experience. Methods: The BCCOE QI curriculum was adapted from programs from Dana-Farber Cancer Institute and Partners In Health-Rwanda and included didactic training, mentored QI projects and leadership development. Prior to the program, staff QI needs, experiences and perspectives were assessed through two focus group discussions (FGDs) with 18 participants. Written surveys assessed staff QI self-efficacy and knowledge immediately before and after a one-day training. Three BCCOE clinicians selected as QI mentors received an additional 3-day intensive training and longitudinal coaching by Rwanda- and US-based QI coaches. Mentors worked with clinician colleagues and coaches to identify quality gaps and devise and implement metric-based QI projects. Results: FGD participants expressed eagerness to engage in QI efforts but identified challenges to QI implementation, including insufficient time, staff and financial resources. Forty oncology staff members (70% nurses) participated in one-day didactic trainings; 37 completed pre- and post-surveys. Perceived QI knowledge, confidence applying QI methods, and perception of adequate time for QI improved after the training (p&amp;lt;0.001 for all using paired t-tests). Mean performance on knowledge assessment items increased from 64% to 73% (p=0.001). Mentor-led teams designed and launched projects to: improve cancer staging/documentation before treatment; increase chemotherapy order double-checking; and reduce chemotherapy wait times. Conclusions: BCCOE's QI program has engaged oncology clinicians as QI leaders and participants, building a culture of team-based QI. Didactic training increased staff self-efficacy and knowledge, facilitating successful launch of projects. Future assessments will examine staff experience, attitudes and knowledge after project engagement. Citation Format: Fidele Sebahungu, David Tuyisenge, Lori Buswell, Olivier Habimana, Esperance Benemariya, Fred Mugabo, Aphrodis Ndayisaba, Cyprien Shyirambere, Hubert Tuyishime, Yeonsoo Sara Lee, Catherine Stauber, Jessica Cleveland, Sarah Kadish, Spyridon Potiris, Dan Gunderson, Temidayo Fadelu, Jean Bosco Bigirimana, Anatole Manzi, Lydia Pace. Building a Culture of Quality Improvement at Butaro Cancer Center of Excellence in Rwanda [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 49.

Dr QI - A quality improvement (QI) approach to designing and delivering QI training

AimsTo develop and implement a QI training programme for trainees, Trust grade doctors and Consultants in Nottinghamshire Healthcare NHS Trust (NHFT) to enable them to deliver change in practice through acquisition of new knowledge and practical application of skills in QI projects using Model for Improvement.BackgroundQI is crucial to improve patient care. Doctors are uniquely placed to input into patient safety and service delivery of healthcare. The skills required to be future clinical leaders and undertake improvement work are not innate and formal teaching and support is required.What is DrQI?DrQI is a trainee-led QI teaching programme developed in collaboration with Trainees improving patient safety through QI (TIPSQI) in North West deanery.MethodA pre-implementation survey amongst doctors in NHFT in February 2019 (33 responses) suggested that 90% of doctors were interested in learning QI and about 48% preferred face-face workshops with support from the QI team.A list of change ideas were created using a driver diagram with QI education and project support identified as key primary drivers.PDSA cyclesNine interactive workshops teaching key QI concepts (based on model for improvement) in NHFT, training more than 100 doctors. A workshop in Derbyshire Healthcare NHS Foundation Trust (70 doctors) and Nottingham University Hospital (20 doctors). Workshops were continually adapted based on qualitative and quantitative feedback. Different formats were tried including virtual sessions, game-based and problem-based learning approaches using small group activities.ResultPre-course and post-course questionnaires were used to assess change in understanding of individual components of QI methodology (SMART Aim, Driver diagram, PDSA cycles, outcome and process measures and run charts). Mean pre-course self-assessment score collated from seven QI workshops in NHFT (2019-2020) was 3.3 and mean post-course score was 7.68, showing an improvement in understanding of QI methodology.Participants were asked to score the relevance (8.4) and quality of teaching (8.4) and the support from the QI team (7.4) on a scale of 1-10 (1 = poor and 10 = excellent). Additional free text feedback was obtained to help us improve the teaching programme.ConclusionCollaborative leadership trainee-led initiative to increase the QI capacity. A bottom up approach to complement the top down approach from the Trust QI team. Future steps include further collaboration and expansion of the scheme to other Trusts, Train the trainer sessions and building a network of QI champions.

Value of Interprofessional Education: The VA Quality Scholars Program.

Interprofessional collaboration (IPC) has been shown to improve healthcare quality and patient safety; however, formal interprofessional education (IPE) training is insufficient. The VA Quality Scholars (VAQS) program exists to develop interprofessional leaders and scholars in healthcare improvement. The purpose of this study was to examine the impact of integrating interprofessional healthcare learners and designing an interprofessional curriculum for the national VAQS program. VAQS alumni (graduates from 2001 to 2017) across eight national sites (n = 102 [53.1%]) completed a web-based survey to assess alumni perceptions of IPC skill development during the program and IPC skill utilization in their careers. Alumni from 2009 and earlier were physicians; alumni after 2009 came from diverse health professional backgrounds. Overall, IPC and teamwork was identified as the most used skill (n = 82, 70%) during their career. When comparing the pre-IPE period and the post-IPE period, post-IPE alumni identified IPC and teamwork as the area of greatest skill development (n = 38). Integrating interprofessional trainees and robust IPE curricula enhanced an established and successful quality improvement (QI) training program. VAQS alumni endorsed the importance of IPC skills during their careers. The VAQS program is an example of how health professionals can successfully learn IPC skills in healthcare QI.

An Active-Learning Quality Improvement Curriculum for Faculty in Hospital Medicine.

Despite the growing importance of quality improvement (QI) training in medical education, there is a lack of faculty with expertise in QI at many academic medical centers. In this report, we describe the design, implementation, and evaluation of a QI training program for faculty in hospital medicine at an academic medical center aimed at increasing faculty capacity in QI. With input from an initial focus group of hospital medicine faculty, we developed a 12-session, active-learning curriculum incorporating core concepts in QI applied to a real-life QI problem. We used a survey instrument to assess changes in self-reported confidence, the Quality Improvement Knowledge Application Tool-Revised to assess changes in applied knowledge, and a second focus group to obtain qualitative feedback regarding the curriculum. Self-reported confidence in numerous QI skills increased after completion of the curriculum; however, concurrent improvement in applied knowledge was not observed. Qualitatively, participants not only described improved understanding of QI methodology and greater confidence contributing to QI initiatives but also a sense they were not prepared to lead a QI project independently. An active-learning faculty training program is feasible with limited resources and was associated with increased faculty confidence in QI skills.

Epilogue: Reflections from International Mentors of the Quality Improvement Training Programme in India.

The article collates the narratives of experiences of the international faculty who mentored the quality improvement teams from India since 2017.

The LEAP Program: Quality Improvement Training to Address Team Readiness Gaps Identified by Implementation Science Findings

BackgroundIntegrating evidence-based innovations (EBIs) into sustained use is challenging; most implementations in health systems fail. Increasing frontline teams’ quality improvement (QI) capability may increase the implementation readiness and success of EBI implementation.ObjectivesDevelop a QI training program (“Learn. Engage. Act. Process.” (LEAP)) and evaluate its impact on frontline obesity treatment teams to improve treatment delivered within the Veterans Health Administration (VHA).DesignThis was a pre-post evaluation of the LEAP program. MOVE! coordinators (N = 68) were invited to participate in LEAP; 24 were randomly assigned to four starting times. MOVE! coordinators formed teams to work on improvement aims. Pre-post surveys assessed team organizational readiness for implementing change and self-rated QI skills. Program satisfaction, assignment completion, and aim achievement were also evaluated.ParticipantsVHA facility-based MOVE! teams.InterventionsLEAP is a 21-week QI training program. Core components include audit and feedback reports, structured curriculum, coaching and learning community, and online platform.Main MeasuresOrganizational readiness for implementing change (ORIC); self-rated QI skills before and after LEAP; assignment completion and aim achievement; program satisfaction.Key ResultsSeventeen of 24 randomized teams participated in LEAP. Participants' self-ratings across six categories of QI skills increased after completing LEAP (p< 0.0001). The ORIC measure showed no statistically significant change overall; the change efficacy subscale marginally improved (p < 0.08), and the change commitment subscale remained the same (p = 0.66). Depending on the assignment, 35 to 100% of teams completed the assignment. Nine teams achieved their aim. Most team members were satisfied or very satisfied (81–89%) with the LEAP components, 74% intended to continue using QI methods, and 81% planned to continue improvement work.ConclusionsLEAP is scalable and does not require travel or time away from clinical responsibilities. While QI skills improved among participating teams and most completed the work, they struggled to do so amid competing clinical priorities.

Training Global Healthcare Providers in Quality Improvement Methodologies for Enhanced Infection Prevention and Control Outcomes

<h3>Background</h3> Continuous quality improvement (QI) has become an essential process for healthcare in the United States. However, QI is still nascent in global healthcare settings and many healthcare providers are unfamiliar with QI methodology. We set out to provide training in QI to assist global healthcare providers in their efforts to impact infection prevention and control (IPC) at their institutions. <h3>Methods</h3> We designed a QI training program that incorporates the Define, Measure, Analyze, Improve, and Control (DMAIC) Methodology of Six Sigma and many Lean tools (e.g. PDSA, 5S, Visual Management, Kaizen). Over 6 months and 6 modules (Module 1: Introduction to QI, Module 2: Define, Module 3: Measure, Module 4: Analyze, Module 5: Improve & Lean Tools, and Module 6: Control) participants reviewed prerecorded seminars, attended bi-weekly online live sessions with an expert, workshopped QI tools and applied them to their own contexts, and completed pre- and post-tests. <h3>Results</h3> Knowledge gain was significant between pre-test and post-test for each module (p < 0.001) and the overall course (p < 0.001). Participants who attended the sessions either agreed or completely agreed that the content of each module was relevant to their daily practice (100%). Participants commented that "this is extremely helpful, but very challenging. This will give new tools [for] our practice" and "I'm hoping I can change the way I do things in my day to day, especially in the infection prevention and control committee". Select individual reports indicate that participants have used QI methodology for better IPC program organization and performance, and for better healthcare delivery. <h3>Conclusions</h3> High post-test scores indicate that online training can be a successful venue for mentoring global healthcare providers in QI methodology. Participants expressed high appreciation for QI methodology and, though concepts were new and challenging, found it to open possibilities for improving processes and outcomes onsite.