Transcript Slide 1

Quality and safety educational
training programmes
and how we evaluate them
Conflicts of interest
•
•
•
•
•
Ekaterine Rukhadze – none
Rob Bethune – none
Jane Runnacles – none
Jo-Inge Myhre – none
Jessica Perlo - none
twitter - #d4
#quality2014
Quality and Safety should be
included in the Curriculum of
Medical Universities
Eka Rukhadze MD, PhD
Nino Butskhrikidze MD
David Tvildiani Medical University;
Medical Alliance for Quality and Safety
International Forum on QUALITY&SAFETY in HEALTHCARE,
Paris 2014
Health Care is Hazardous
Leape LL. Presentation at the Public’s health: a matter of trust symposium, 2002.
Harvard University School of Public Health
Incidence of Medical
Errors
Leape LL. Errors in medicine. Clinica Chimica Acta2009;404:2-5.
MacDermaid LJ. First, do no harm: medical error in Canada. 2005
Status of patient safety in
Georgia
• Lack of knowledge
• Seriousness of the situation is not
acknowledged
• Unavailability of objective data
Goals and Objectives
• To improve the knowledge in Quality and
Patient Safety
• To introduce an evidenced based
approach to quality and safety
• To create the course curriculum
Course Design
• David Tvildiani Medical University
• Target Audience:
– 5-th year students
– PhD students
• 16 academic hours (8 seminars)
• Testing (pre- and post-tests)
• Course evaluation
Educational Recourses for
Course Curriculum
• Online Courses in Patient Safety (PS 100- PS 106)
www.ihi.org
– Medical Quality/Safety. CHOP Seminar In Salzburg, 2013
– R.M. Wachter. Understanding Patient Safety, The
McGraw-Hill, 2008
– Gary Cook. Introduction to patient Safety; www.bmj.org
– Imran Qureshi. Quality and safety in healthcare;
www.bmj.org
– P.R. Scholtes et all, The Team Handbook, 2010
Content of the Course
•
•
•
•
•
•
Introduction to Patient Safety
The System Reasons of Medical Errors – Blunt End
The Individual Reasons of Medical Errors – Sharp End
Types of Medical Errors
Response on Errors
Strategies of Improvement
Results
Students -2013
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
51%
28%
Pre-test (percentage of
correct answers)
23%
Post-test (percentage of
correct answers)
Improvement
Results
PhD students -2014
100%
90%
80%
64%
70%
60%
50%
40%
37%
27%
30%
20%
10%
0%
Pre-test (percentage of correct
answers)
Post-test (percentage of
correct answers)
Improvement
Comparison of TEST
RESULTS
Students -2013
PhD students -2014
100%
100%
80%
80%
51%
60%
40%
28%
64%
60%
23%
40%
20%
20%
0%
0%
Pre-test
Post-test Improvement
(percentage (percentage
of correct
of correct
answers)
answers)
37%
27%
Pre-test
Post-test Improvement
(percentage (percentage
of correct
of correct
answers)
answers)
Results
Course evaluation by Students - 2013
2% 0% 3%
13%
very good
good
47%
fair
poor
very poor
35%
no response
Results
Course evaluation by PhD students - 2014
20%
very good
good
fair
62%
36%
poor
very poor
no response
Comparison of
EVALUATION
Students - 2013
2% 0%
PhD students - 2014
3%
very good
13%
47%
good
good
fair
fair
poor
35%
very good
20%
very poor
no response
36%
62%
poor
very poor
no response
Results
Suggestions about particular topics – PhD 2014
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
100%
100%
80%
80%
60%
60%
40%
20%
Introduction to
Patient Safety
40%
20%
The System
The Individual
Types of Medical Response on Errors
Reasons of Medical Reasons of Medical
Errors
Errors
Errors
Strategies of
improvement
information is enough
should be more detailed
Summary
• Improvement was achieved in both cases (23%/27%)
• The course was more interesting for PhD students (very good: 62%/47%)
• Course evaluation shoes more interest in practical topics comparing
theoretical issues
– For 100 % of attendees the information of Introduction part was
sufficient
– For 80 % of attendees the information about System Reasons of Errors
was sufficient
– For 100 % of attendees the information about Strategies of
Improvement was insufficient
– For 60 % of attendees the information about the Individual Reasons of
Medical Errors was insufficient
– For 60 % of attendees the information how to Respond on Errors was
insufficient
– For 80 % of attendees the information about the Types of Errors was
insufficient
Question?
Should Quality and Safety be
included in the Curriculum of
Medical Universities?
Answer
Yes
and it is not sufficient!
Future Plans
Training and Educational
System for all level of
Medical Facilities
Already done
• Foundation of
association “Medical
Alliance for Quality and
Safety” - MAQS
• Support from the
Ministry of Health,
Labour, and Social
Affairs of Georgia
Thank YOU!
Open School
19th Annual International Forum on
Quality and Safety in Healthcare
This presenter has nothing to disclose
D4: Bridging the gap
between undergraduate
and postgraduate education
Jo-Inge Myhre, MD and Jessica Perlo, MPH
April 10, 2014
Meet Dan
28
Took Courses & Created a Chapter
IHI Open School
working group
Motivated and
passionate
volunteers
Weekly meetings
Leveraged Faculty
Partnership with institutional
leadership, secured a mandate
Georgetown Center for Patient Safety
Georgetown Masters in Health System
Administration
Georgetown School of Medicine
- Remove barriers
- Buy faculty time
- Encourage learners to participate
Recruited Interprofessional Members
31
Focused on Institutional Priorities
Engaged students/trainees in projects that were central
to the strategic plan of their health care organization
For them, this meant:
– Resident handoffs
– Central line blood stream infections
– Hospital readmissions
– DVT prophylaxis improvement
– Post discharge communication with community primary care
physicians
– Hand hygiene
– Central line air embolism prevention
– Private partnership with an industry partner
Built the Case for Resident
Involvement
System dysfunction is never more evident than when
one is in training.
– Because of the unfortunate nature of our training system,
trainees are often blamed for system errors
Because of this front line view, there is a tremendous will
for change among trainees.
They are tremendously agile in their thought processes
and are not attached to an ingrained status quo.
They rarely have the opportunity to work in an
interprofessional manner.
Practicum example: CLABSI
Team structure:
– Health system administration student: project manager, Daniel
–
–
–
–
Bitman, BS
Physician champion: medicine resident, Daniel Alyeshmerni, MD
Nursing champion: Elizabeth Giunta, RN
Medical student: Orlando Sabbag, MSIII Peter Aleksandrov, MSIII
Nursing student: Lindsay Gingras
Barriers: time, focus,
maintaining momentum
Results:
– On vascular surgery unit, CLABSI rate
~ 3.2/1000 device days to 0 CLABSI
rate for over one year
Continued Professional Growth
Presented work at
conferences
Quality Improvement
Chief Resident, DC VA
VA Quality Scholar
Fellowship
IHI Improvement
Advisor Training
Cardiology Fellowship,
UMI
Faculty Advisor to UMI
Chapter
Dan’s Experience
(Beginning
Prelicensure
Learner)
(Advanced
Prelicensure
Learner)
(Beginning
Postlicensure
Learner)
(Advanced
Postlicensure
Learner)
Competent
Proficient
Novice
Advanced
Beginner
Expert
Student
OS Courses
Resident/
Trainee/
Junior
Doctor
OS Practicum
Faculty
IHI IA, VA Quality Scholar
QI Educator
* Adapted from Ogrinc G, et al. A framework for teaching medical students and residents about
practice-based learning and improvement. Acad Med. 2003; 78(7): 748-756
Actual State
(Beginning
Prelicensure
Learner)
(Advanced
Prelicensure
Learner)
(Beginning
Postlicensure
Learner)
(Advanced
Postlicensure
Learner)
Novice
Advanced
Beginner
Competent
Proficient
Expert
Student
OS Courses
Resident/
Trainee/
Junior
Doctor
OS Courses
Faculty
OS Courses
QI Educator
* Adapted from Ogrinc G, et al. A framework for teaching medical students and residents about
practice-based learning and improvement. Acad Med. 2003; 78(7): 748-756
Early Postlicensure Barriers
Junior Doctor/Residents’ busy schedules
Not enough mentors who feel comfortable providing
guidance
Lack of interest among trainees or belief that QI/PS is
unimportant
Trainees’ transient presence on certain units or rotations
Lack of time to teach basic foundational principles of
quality and safety
Lack of infrastructure (data managers, statisticians)
Lack of support from residency leadership regarding
perceived value of these activities
Graduate Training Success Factors
1. Health system culture embraces the idea that residents
2.
3.
4.
5.
and junior doctors are critical to quality and safety.
Engaged, capable faculty are willing to mentor.
Training projects are aligned with quality and safety
institutional goals.
Early student exposure to QI concepts can create
champions and a pathway for application once they
enter the delivery system
Ongoing, experiential learning opportunities allow deep
practice.
IHI Open School Mission
“Advance health care improvement and patient safety
competencies in the next generation of health
professionals worldwide.”
The IHI Open School
Curriculum
Content
Community
Networks
Experiential
Learning
IHI Open School Courses
• 23 online courses developed by world-renowned
experts in the following topics:
• Improvement Capability
• Patient Safety
• Person- and Family-Centered Care
• Triple Aim for Populations
• Quality, Cost, and Value
• Leadership
• Mobile App for iPhone and iPad
Certificates
Certificate of
Completion
30 contact hours
available for nurses,
physicians, and
pharmacists
Community
Physician
Assistant
200,000+ students,
residents, and
professionals
638 Chapters in 67
countries
167 Chapters (26%)
are located in
hospitals or health
systems
Pharmacy
Social Work
Allied
Health
Professions
Business
Occupation
al &
Physical
Therapy
Dentistry
Engineering
Nursing
Medicine
Law
Health
Science &
Administrat
ion
Quality Improvement Practicum (QI201)
Learner-driven quality improvement projects
Within local clinical setting
Opportunity to apply gained knowledge
Project Examples:
– Reducing wait times
– Improving hand hygiene compliance rates
– Improving medication processes and implement
checklists
Combining QI&PS with
Leadership Training and EBM
Jo Inge Myhre, MD
Teaching assistant ”KLoK”
University of Oslo Medical School
Aim of KLoK
Through KLoK you’ll aquire knowledge and skills in
EBM, leadership and quality improvement. This will aid
you in your future professional role as an individual as
well as a member/leader of teams.
Course overview
1. sem.: Introduction to patient safety (lecture)
6. sem.: Leadership and patient safety (seminar)
7. sem.: One week course in EBM (with exam)
10. sem.: EBM, Leadership and QI, Lectures, seminars and individual
assignments during rotations in both hospitals and primary care
–
–
–
Critical analysis of scientific publication and or guideline
Patient satisfaction
”The patient’s journey”
11. semester:
–
–
Lectures and seminars
Group based assignment (QI Project proposal)
12. semester:
–
–
–
”Survival week”
Student-BEST – Interprofessional simulation day
OSCE
Our experience
It’s hard to teach one subject without the others
Making it as clinical as possible is crucial
Invite students in the process
Create mechanism for continuous evaluation of the
course
QUESTIONS?
Email [email protected]
Like us on Facebook
Follow us on Twitter
@IHIOpenSchool
Download our App
• What’s happening in your organisation at the
moment in terms of quality improvement and
safety training programmes
Plan- do- evaluate- act cycle
Future curricula should be evaluated based on
whether learner’s attitudes, knowledge and
skills improve, especially when improvements
are ‘associated with intermediate clinical gains’
• Effectiveness of Teaching Quality
Improvement to Clinicians: a systematic
review (Boonyasai et al, 2007)
• Quality Improvement in medical education:
current state and future directions (Wong et
al, 2012)
Kirkpatrick Evaluation Model
4 Results
3
Behaviour
2 Learning
1 Reaction
Kirkpatrick Evaluation Model
4 Results
Results for the organisation:
quality, efficiency,
productivity
3
Behaviour
Change in behaviour
(knowledge/skills applied on
the job)
2 Learning
Increase in knowledge, skills
or attitudes?
1 Reaction
Satisfaction- Valuable,
Relevant?
• Pre- and post- programme: QI attitudes,
knowledge & skills (Likert scale rating)
• Benefit to learners
• Benefit to organisation
• 2 year follow-up questionnaire
Challenges
Demonstrating
benefits to
patients/organi
sation (level 4)
Difficulties
measuring
behaviour
change (level
3)
Lack of tools to
assess QI
knowledge & skills
(level 2)
PLUS control
group
Questionnaires
• Up to level 2 – attitudes, self reported
knowledge and skills
• Not so good at measuring behaviour, values
and competencies
‘Validating a questionnaire’
• Modified Delphi technique - adapt
• Then trial it with participations – adapt
• Then sit down with them while they are filling
it out and find out what they are thinking adapt
…but to do behaviours, values and
competencies (level 3)
you need interviews
• Probably the best way
• Expensive and takes time – long follow up is
best
• What are you going to take away from this
talk?
The Road Ahead