Transcript Sickle Cell Quality Improvement Project

DEVELOPMENT OF FACULTY MENTORS IN QUALITY IMPROVEMENT AND
PATIENT SAFETY – A TIERED APPROACH FOR FACULTY ENGAGEMENT
Leslie W. Hall, MD; Linda A. Headrick, MD, MS; Douglas S. Wakefield, PhD - University of Missouri Health Care
Center for Healthcare Quality; School of Medicine; University of Missouri - Columbia
Abstract
Background: The University of Missouri is
creating a continuum of learning for medical
students, residents, and faculty to produce
physicians committed to quality improvement (QI)
and patient safety. In response to student
feedback indicating that these values were
variably reflected by faculty during clinical
experiences, professional development
opportunities in QI and patient safety were made
available to faculty beginning in 2004.
Methods: Three programs were offered to
selected faculty physicians from nine
departments, targeting educational and clinical
leaders. Faculty roles and time available for
training determined the intensity of training
chosen. All programs included both classroom
sessions and facilitated experiential learning.
Through early 2010, 26 faculty members
completed a twelve hour interprofessional
QI/patient safety training program involving
students, residents and hospital staff. Thirteen
faculty physicians completed an interprofessional
performance improvement leadership
development course, receiving 42 hours of
instruction over six months. Ten faculty members
completed intensive off-site QI training at
Intermountain Health Care in Salt Lake City,
Utah.
Results: After completing entry-level training,
nine faculty physicians requested more intensive
training. Twenty-two trained faculty members
subsequently served as mentors to QI teams and
15 of these faculty members participated in the
teaching of QI/patient safety to learners. Eightysix percent of trained faculty members
participated in additional quality improvement
projects in the two years following their training.
Conclusions: Training of faculty physicians in
QI/patient safety produced a cadre of physicians
who mentor others in improvement skills and who
serve as role models to learners by incorporating
improvement skills into their clinical work.
Three Tiers of QI Training
A variety of options for QI training of faculty have
been made available, based upon the needs,
interests and roles of faculty members.
Tier 1 – ACT program: Entry-level QI training
experience ideally suited for faculty
members who wish to better understand
and support QI efforts in their departments.
Tier 2 - PI Leadership Development Course
(PI-LDP) designed to develop QI team
leadership skills.
Tier 3 - External training with the Advanced
Training Program (ATP) or mini-ATP course
at Intermountain Health Care. Ideal for
institutional QI leaders.
Tier 3
ATP or mini-ATP Course
Tier 2
Tier 1 – ACT Program
Tier 3 – ATP or mini-ATP
•Provides twelve hours of classroom time
•Improvement teams meet every one to two weeks
•Learners imbedded within each improvement team
•Institutional leaders in QI are encouraged to
complete the ATP course (20 days over
four months) or mini-ATP course (11
days over four months) at Intermountain
Health Care in Salt Lake City, Utah.
•Those leaders completing this course now
serve as the core faculty to teach our
ACT and PI-LDP courses.
Topics Covered:
IOM aims for quality care
Understanding quality gap
Developing an aim statement
Characteristics of healthy
teams
Root cause analysis
Overcoming barriers to change
Cause and effect diagrams
Process flow charting
Establishing appropriate
metrics
Stakeholder identification
and engagement
Change management
Tier 2 – PI-LDP Course
•Provides 42 hours of classroom time
•Improvement teams meet every one to two weeks
PI Leadership Development Course
Tier 1
“Achieving Competence Today” QI Training Course
Common Elements of
All Three Programs
Experiential training in QI, with participants
completing a QI project which addresses a
real health care delivery concern within our
health system
Large group educational sessions teaching QI
principles that can be applied to the project
QI experts available to mentor participants
Interprofessional learning environment
Requirement for end-of-course presentation of
project results
Outcomes
•A systematic approach to building capacity
in the teaching/mentoring of quality
improvement has greatly expanded the
base of faculty trained in QI skills:
Forty distinct faculty trained to date
Most faculty trained have remained
involved in leading or facilitating QI
teams or teaching QI following their
training.
Six residents trained as part of ACT
program now are faculty members.
Topics Covered:
Setting the stage for
improvement
Understanding process
dependency
Developing an aim statement
Value Stream mapping
Spaghetti diagrams
Team formation, roles
Optimizing team performance
Managing team conflict
Silent brainstorming and affinity
diagrams
Team decision-making
Root cause analysis
Identifying stakeholder issues
Value-driven health care
Run charts and control
charts
Pareto analysis
Coaching teams to improve
care
Measuring work flow
Cause and effect diagrams
Establishing appropriate
metrics
Failure mode effects
analysis
Use of external data
sources
PI in practice
Change management skills
Quality transparency
Next Steps
•Continue to expand the number of faculty
trained in QI skills, targeting those
departments less well represented in prior
training.
•Continuously improve the QI training based
upon learner feedback and measurement
and analysis of educational outcomes.