Quality Improvement Training Research Articles

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.

Whistle while you work: improving psychiatry training in a London NHS Trust and what we learned along the way

AimsThe aim of this project is to improve the training experience of Psychiatry trainees across CNWL. In QI terms, we want to achieve a satisfaction rating of above 7/10 for all themes identified by August 2021.MethodCollected baseline data on satisfaction and priority ratings on 7 training themes Held discussion groups with trainees for specific themes to generate issues and solutions Developed and provided Quality Improvement training for trainees and trainers, 1:1 support and QI clinics – empowering trainees to develop their own local project and to make changes to issues on the ground Enacted central changes in communication, responsiveness, recognising success.Reassessed and fedback to the trainees throughout.ResultOur baseline satisfaction survey was completed in June 2020. Trainees their satisfaction for each theme out of 10 and to rank their priorities for change. Results showed satisfaction was lowest in morale and in safety and highest in education and supervision. Their highest priorities for change were safety, then morale, with induction as the lowest priority.We repeated the survey in October 2020. This showed improvements in most themes (apart from induction, perhaps due to induction having to be delivered virtually). Satisfaction in key priority areas of morale and safety increased from 4.53 to 6.37, and 5.12 to 6.70 respectively. We also asked what ‘one thing’ would they improve about their training. Key phrases included teaching, on-call, communication and induction.From this data, and softer feedback from trainees, it is encouraging that we are moving in a positive direction, but we are continuing to make changes.Conclusion•Trainees must be central to the work in improving their training•Using QI methodology helps – developing a structure and breaking down a bigger task helps make a plan•Feedback is key – but people are busy and receive a lot of emails and requests to fill surveys – catching people ‘in person’ (virtually) was the best way to ensure a lot of responses•Trainees have loads of great ideas, but they need support, time and resources to be able to develop their projects and changes•Flexibility is crucial: some topics work better locally, driven by trainees and some require a more coordinated, central roleWe hope that developing a structured approach to a large task like improving training will help make changes sustainable, and enables us to share our learning with others.

Simulation Use in Quality Improvement and Patient Safety Training for Residents.

Simulation Use in Quality Improvement and Patient Safety Training for Residents.

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 experiential learning collaborative on quality improvement for interprofessional learners

ABSTRACT Growing evidence supports the need to teach future healthcare practitioners the fundamentals of quality improvement (QI), but curricula rarely include opportunities to apply QI principles or develop relevant teamwork skills. We initiated a program in 2017 called QUEST to engage our learners in interprofessional health care improvement through a 7-month learning collaborative. QUEST pairs learners with mentors in clinical QI teams and provides structured content, tasks, and feedback. The model is intentionally experiential, intended to use existing expertise and opportunities in the clinical learning environment to support QI training. Three cohorts of health professions learners have completed QUEST (n = 45), resulting in 27 unique quality improvement projects and poster presentations. QI knowledge, as measured by the QIKAT-R, increased from 5.48 to 6.34 on a 9-point scale (p = .01). Teamwork readiness also improved: ISVS-9B scores increased from 5.25 to 6.23 on a 7-point scale (p < .01). Feedback has been positive with participants noting the unique learning opportunity, benefit to learner professional development, and enjoyment found in working across professions. QUEST continues to grow each year. Ongoing modifications are addressing mentor development and curricular standardization.

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.

Quality improvement training for burn care in low-and middle-income countries: A pilot course for nurses

BackgroundThere is an urgent need to empower practitioners to undertake quality improvement (QI) projects in burn services in low-middle income countries (LMICs). We piloted a course aimed to equip nurses working in these environments with the knowledge and skills to undertake such projects. MethodsEight nurses from five burns services across Malawi and Ethiopia took part in this pilot course, which was evaluated using a range of methods, including interviews and focus group discussions. ResultsCourse evaluations reported that interactive activities were successful in supporting participants to devise QI projects. Appropriate online platforms were integral to creating a community of practice and maintaining engagement. Facilitators to a successful QI project were active individuals, supportive leadership, collaboration, effective knowledge sharing and demonstrable advantages of any proposed change. Barriers included: staff attitudes, poor leadership, negative culture towards training, resource limitations, staff rotation and poor access to information to guide practice. ConclusionsThe course demonstrated that by bringing nurses together, through interactive teaching and online forums, a supportive community of practice can be created. Future work will include investigating ways to scale up access to the course so staff can be supported to initiate and lead quality improvement in LMIC burn services.

ICRE Abstracts: Quality Improvement

ICRE Abstracts: Quality Improvement

The Importance of Quality Assurance and Quality Improvement in Low- and Middle-Income Settings

Purpose of ReviewThis review will discuss the importance of quality improvement in low- and middle-income settings as well as several potential barriers to these measures.Recent FindingsThere is substantial potential for growth in the field of quality improvement in low-resource settings. The extent of quality improvement (QI) research in low-resource settings is limited but expanding.SummaryPatient harm that is attributable to the costs of poor quality is a significant factor in all practice settings but is arguably of greater impact in limited-resource settings. Due to the recognized human, physical, and technological resource limitations in low- and middle-income countries, the delivery of quality healthcare can be variable in many settings, with discrepancies in evidence-based, evidence-informed, and customary care processes. Disparities in training and development of workforce providers exist in addition to limited availability of funding for QI research. Governmental, health ministry, and health system support is also variable. Attention to all of these areas is ultimately necessary to implement affordable and realistic quality improvement initiatives, education, training, and patient safety strategies that can mitigate harms, improve and establish more reliable outcomes, and develop a culture of safety to grow more sustainable and effective workforces and systems.

Implementation and Evaluation of Quality Improvement Training in Surgery: A Systematic Review.

The aim of this study was to review and appraise how quality improvement (QI) skills are taught to surgeons and surgical residents. There is a global drive to deliver capacity in undertaking QI within surgical services. However, there are currently no specifications regarding optimal QI content or delivery. We reviewed QI educational intervention studies targeting surgeons or surgical trainees/residents published until 2017. Primary outcomes included teaching methods and training materials. Secondary outcomes were implementation frameworks and strategies used to deliver QI training successfully. There were 20,590 hits across 10 databases, of which 11,563 were screened following de-duplication. Seventeen studies were included in the final synthesis. Variable QI techniques (eg, combined QI models, process mapping, and "lean" principles) and assessment methods were found. Delivery was more consistent, typically combining didactic teaching blended with QI project delivery. Implementation of QI training was poorly reported and appears supported by collaborative approaches (including building learning collaboratives, and coalitions). Study designs were typically pre-/post-training without controls. Studies generally lacked clarity on the underpinning framework (59%), setting description (59%), content (47%), and conclusions (47%), whereas 88% scored low on psychometrics reporting. The evidence suggests that surgical QI training can focus on any well-established QI technique, provided it is done through a combination of didactic teaching and practical application. True effectiveness and extent of impact of QI training remain unclear, due to methodological weaknesses and inconsistent reporting. Conduct of larger-scale educational QI studies across multiple institutions can advance the field.

A Changing Landscape: Exploring Resident Perspectives on Pursuing Pediatric Hospital Medicine Fellowships.

Pediatric Hospital Medicine (PHM) was approved as a subspecialty in 2016. Perspectives of pediatric and combined pediatric residents regarding barriers and facilitators to pursuing PHM fellowships have not previously been assessed. A survey to explore residents' perspectives on PHM fellowships, with questions regarding demographics, likelihood of pursuing PHM after fellowship introduction, and influencing factors was distributed to pediatric and combined pediatric residents via program directors. The survey was distributed to an estimated 2657 residents. A total of 855 (32.2%) residents completed the survey; 89% of respondents had at least considered a career in PHM, and 79.4% reported that the introduction of the PHM fellowship requirement for subspecialty certification made them less likely to pursue PHM. Intent to practice in a community setting or only temporarily practice PHM, Combined Internal Medicine and Pediatric trainee status, and high student loan burden were associated with decreased likelihood of pursuing PHM (P < .05). Most respondents reported that forfeited earnings during fellowship, family and student loan obligations, and perceived sufficiency of residency training discouraged them from pursuing PHM fellowship. Half of respondents valued additional training in medical education, quality improvement, hospital administration, research, and clinical medicine. Many survey respondents expressed interest in the opportunity to acquire new skills through PHM fellowship. However, the majority of respondents reported being less likely to pursue PHM after the introduction of fellowship requirement for board certification, citing financial and personal opportunity costs. Understanding factors that residents value and those that discourage residents from pursuing PHM fellowship training may help guide future iterations of fellowship design.

Implementation of Telemental Health (TMH) psychological services for rural veterans at the VA New York Harbor Healthcare System.

Meeting the mental health needs of our current veteran population is one of the primary challenges facing the Veteran's Health Administration (VHA). Particularly for veterans residing in rural areas, the lack of providers, high provider turnover, and the burden of traveling long distances to VHA facilities may contribute to difficulties accessing mental health care. Telemental Health (TMH) services help bridge the geographic gap between mental health providers and veterans who need mental health services. The VHA TMH Hub initiative has attempted to leverage changes in technology-facilitated care by developing a model in which a facility "hub" could expand mental health resources to remote "spoke" clinics and veterans' residences. This paper describes the implementation of the VA New York Harbor Health care System (VA NYH) TMH Hub, which was one of 6 programs funded by the VHA Office of Rural Health (ORH) in September 2016. We will describe the structure of the program, services provided, veterans served, and our efforts to integrate quality improvement, research, and clinical training into the operations of the program. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Applying improvement science to establish a resident sustained quality improvement (QI) educational model

BackgroundPrior to 2017, internal medicine (IM) residents at the University of Alberta did not have a standardised quality improvement (QI) educational curriculum. Our goal was to use QI principles to...

What key stakeholders think about CLIL programmes: Commonalities and differences of perspective

The goal of this study is to critically discuss some of the most controversial issues affecting the characterization and implementation practices of CLIL (Content and Language Integrated Learning) programmes from key stakeholders' perspective (teachers, learners and parents). The focus will be placed on examining their voices on what CLIL education actually means, its alleged potential benefits in terms of enhanced L2 competence and increased L2 exposure and use, whether content knowledge is improved by CLIL instruction, whether content is emphasised over language in CLIL assessment and, lastly, whether teachers and learners feel motivated and satisfied with the CLIL experience. With this in mind, and based on methodological triangulation, this paper follows a mixed-method research design for investigating the commonalities and differences of perspective. The stakeholders' voices we draw on in this paper largely coincide with most expectations and with what has been reported in the CLIL literature, though, surprisingly, not all view the need for L2 exposure and use in CLIL classes in the same way. On the whole, CLIL is positively evaluated by all stakeholders, provided these educational programmes are well articulated and effectively implemented in practice, although there is always room for further quality improvement and teacher training.

QIC: A Pilot Quality Improvement Curriculum Utilizing Interactive, Team-based Workshops

BackgroundIncorporation of quality improvement (QI) training is essential to meet the milestones set forth by the Accreditation Council for Graduate Medical Education. However, there is no standardized curriculum. ObjectiveWe aimed to create a QI curriculum through the integration of didactics and team-based learning via the completion of resident-led QI projects. MethodsAn institutional review board–approved QI curriculum consisting of four interactive workshops was developed. The workshops introduced the various components of QI, with a focus on Plan-Do-Study-Act. Anonymous and voluntary precurriculum and postcurriculum surveys were administered during the study period in 2018. ResultsFifty surgical residents participated in the curriculum, and four QI projects were completed, with 23 residents completing both precurriculum and postcurriculum surveys. Following the curriculum, residents were more confident in their ability to design a QI project (5.7 ± 2.6 versus 7.1 ± 1.9, P = 0.02), write a problem statement (6.7 ± 2.5 versus 7.8 ± 1.1, P = 0.04), and write an aim statement (6.7 ± 2.6 versus 7.8 ± 1.2, P = 0.04). Residents also improved in perceived ability to lead a QI project (5.6 ± 2.9 versus 6.9 ± 1.9, P = 0.05), knowing the steps to complete a QI project (6.0 ± 2.8 versus 7.4 ± 1.7, P = 0.04), and familiarity with QI terminology (5.6 ± 2.6 versus 7.0 ± 1.9, P = 0.03). ConclusionsWe found that the curriculum was a success and was well received. In addition, there was an improvement in perceived competency and confidence surrounding some of the steps necessary to complete a QI endeavor.

A facilitation model for implementing quality improvement practices to enhance outpatient substance use disorder treatment outcomes: a stepped-wedge randomized controlled trial study protocol

BackgroundThe misuse of and addiction to opioids is a national crisis that affects public health as well as social and economic welfare. There is an urgent need for strategies to improve opioid use disorder treatment quality (e.g., 6-month retention). Substance use disorder treatment programs are challenged by limited resources and a workforce that does not have the requisite experience or education in quality improvement methods. The purpose of this study is to test a multicomponent clinic-level intervention designed to aid substance use disorder treatment clinics in implementing quality improvement processes to improve high-priority indicators of treatment quality for opioid use disorder.MethodsA stepped-wedge randomized controlled trial with 30 outpatient treatment clinics serving approximately 2000 clients with opioid use disorder each year will test whether a clinic-level measurement-driven, quality improvement intervention, called Coaching for Addiction Recovery Enhancement (CARE), improves (a) treatment process quality measures (use of medications for opioid use disorder, in-treatment symptom and therapeutic progress, treatment retention) and (b) recovery outcomes (substance use, health, and healthcare utilization). The CARE intervention will have the following components: (1) staff clinical training and tools, (2) quality improvement and change management training, (3) external facilitation to support implementation and sustainability of quality improvement processes, and (4) an electronic client-reported treatment progress tool to support data-driven decision making and clinic-level quality measurement. The study will utilize multiple sources of data to test study aims, including state administrative data, client-reported survey and treatment progress data, and staff interview and survey data.DiscussionThis study will provide the field with a strong test of a multicomponent intervention to improve providers’ capacity to make systematic changes tied to quality metrics. The study will also result in training and materials that can be shared widely to increase quality improvement implementation and enhance clinical practice in the substance use disorder treatment system.Trial registrationTrial #NCT04632238NCT04632238 registered at clinicaltrials.gov on 17 November 2020

P217 Delivering quality improvement coaching in a virtual world: the use of digital technology to empower and engage CFDigiCare clinicians to undertake quality improvement activities nationally

Background: CFDigiCare is a community of practice using digital adherence data, FEV1 and BMI to inform clinical decision-making and comprehensive digital behaviour change tools to support patient self-care. The 16 UK adult CF centres that form CFDigiCare work together using improvement science to embed digital data into routine care. The collaborative uses the Dartmouth Microsystems approach to build quality improvement (QI) capability Most CFDigiCare teams attended a one-day class-based QI training pre-COVID-19, with subsequent coaching delivered online. We discuss digital QI refresher training and coaching to the nationally dispersed improvement collaborative during the COVID crisis. Methods: 1-hour QI refresher training was delivered via MS Teams. Dartmouth improvement ramp activities were undertaken during subsequent 3 sessions. Results: Average attendance was 9. We explored two areas for improvement, teams participated in group ‘Fishbone’ exercises, silent brainstorming, discussed change ideas and planned PDSA cycles. Staff rated the meetings 9.4/10, commenting: • Useful QI demonstration and collaboration of ideas • Jamboard is a useful tool for gathering ideas • Can deliver it to the team • Good feedback for PDSAs Attendance was high with staff valuing practical interactive sessions using facilitated MS Teams calls and tools such as Google Jamboard. Virtual sessions connected clinicians from 16 centres providing a national “hive brain” perspective on system optimisation. The Dartmouth microsystems paradigm focused attention on specific aims, providing a structure to deliver iterative change. Virtual connectivity allowed QI to continue despite COVID-19. Familiarity with MS Teams increased over time with shared mastery of the technology a clear improvement outcome. Conclusion: Digital technology not only supports the delivery of QI training and coaching but can enhance it;clinical teams quickly mastered platforms such as MS Teams and Google Jamboard.

Partnering With Patients in a Quality Improvement Curriculum for Internal Medicine Residents.

Patient experience is a core component of the Institute for Healthcare Improvement Triple Aim for health care improvement. Although resident physicians must meet quality improvement (QI) competencies prior to graduation, QI training during residency may not adequately prepare residents to improve patient and family experience. We describe an active learning QI curriculum engaging 3 Patient and Family Advisors as partners alongside 15 resident physicians. This partnership proved to be a meaningful experience for both groups, with the development of mutual respect and insight into the contributions that patients and families bring to solving problems in health care quality.

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.

Quality Improvement Training Framework Adoption at Katutura Hospital in Windhoek Namibia

In Namibia, most health care facilities have not been yielding good results in response to patients’ health care needs. Health care systems are becoming more complex with paradoxical challenges resulting into inefficiencies due to ever increasing science and knowledge in medicine, which makes it difficult to internalise and understand, as well as to implement certain procedures. The study explored and found that research indicates that total quality management (TQM) and continual quality improvement (CQI) principles can be applied to strengthen a health system to improve its quality. This could be particularly useful in Namibia where people demand basic services and the health service users raise their issues with the Ministry of Health and Social Services (MoHSS). It becomes essential to ascertain the extent to which health care facilities have responded to this call. Against this background, it is important to analyze the responses to QI and QA and how it could be used to develop a framework for quality health care delivery at the health care facilities in Namibia. The main focus of this paper is to identify quality improvement aspects at Katutura Hospital and to develop a quality improvement training framework to empower and equip health professionals with the right knowledge, skills, aptitudes, and behaviours to apply the methods and techniques with the purpose of improving customer service.