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Educating Professionals to Improve Health Care. April 12, 2007 Leslie W. Hall, MD University of Missouri - Columbia. How Do We Educate for Quality?. Key Concepts Integrate material into curriculum to foster gradual increase in expertise Connect to the care of patients Assess outcomes

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Educating professionals to improve health care

Educating Professionals to Improve Health Care

April 12, 2007

Leslie W. Hall, MD

University of Missouri - Columbia


How do we educate for quality

How Do We Educate for Quality?

  • Key Concepts

    • Integrate material into curriculum to foster gradual increase in expertise

    • Connect to the care of patients

    • Assess outcomes

    • Offer interprofessional learning opportunities


Quality safety education at university of missouri

Quality/Safety Education at University of Missouri

  • Interprofessional undergraduate education in quality/safety

  • 3rd year med student safety conferences

  • Achieving Competence Today (ACT) interprofessional curriculum

  • Patient safety crew training

  • Faculty Development

  • IHI Health Professions Education Collaborative


Curriculum on patient safety quality

Curriculum on Patient Safety & Quality

  • Included in 2nd year medical curriculum beginning in 2003

  • 8 hours of instruction

  • Didactic lectures & small group sessions

  • Includes simulated root cause analysis of adverse event


Curriculum on patient safety quality1

Curriculum on Patient Safety & Quality

RT students

MHA

students

2006

Nursing

students

Medical

students


Interprofessional curriculum 2006

Interprofessional Curriculum 2006

Week 1 – Health Care Team

Week 2 – Improving the Health Care System

Week 3 – Patient Safety

Week 4 – Root Cause Analysis


Course evaluation

Course Evaluation

  • Attitudes and self-reported behaviors around patient safety and quality assessed

  • Knowledge – based exam

  • Learner evaluations

Surveys completed:

Preclinical

Clinical

Year 1 Year 2 Year 3 Year 4

Curriculum administered


Educational outcomes

Educational Outcomes

  • Majority of learners felt the interprofessional nature of the training added value

  • Improvements in several patient safety attitudes noted post-training

  • For medical students, by end of third year, some regression in patient safety attitudes occurred.1

1Madigosky, W. S., Headrick, L.A., Nelson, K.J., Cox, K.R., & Anderson, T.

Changing and Sustaining Medical Student Knowledge, Skills, and Attitudes

about Patient Safety and Medical Fallibility. Acad Med 2006; 81:94-101.


Educating professionals to improve health care

# = Significant Change

#

#

(Clinical clerkships)

1=Very Uncomfortable, 3=Neutral, 5=Very Comfortable

Madigosky W, et al. Academic Medicine; 2006


Adding a safety booster

Adding a Safety “Booster”

Patient

SafetyCurriculum

Patient

SafetyBoosters

½ of class – No booster

½ of class – Booster

Year 1 Year 2 Year 3 Year 4

Preclinical

Clinical


Comfort in analyzing a case to find the cause of an error

Comfort in analyzing a case to find the cause of an error…

p = 0.03

1=Very Uncomfortable, 3=Neutral, 5=Very Comfortable


Interprofessional curriculum

Interprofessional Curriculum

2007

45 min intro

lecture

6 Hours of

small group work

Final

presentation


Small group assignments

Small Group Assignments

  • Analyze a case in which an adverse outcome noted

  • Map the process of care

  • Brainstorm system factors contributing to care breakdown

  • Consider system solutions to improve care

  • Create an aim statement and choose a measurement for one proposed improvement

  • Summarize analysis in a brief PowerPoint presentation


Value of ip experience

Value of IP Experience

Percent of students who valued the interprofessional nature of experience


Perceived benefit to career

Perceived Benefit to Career

Percent of students who felt experience would benefit future career


Potential outcomes measurements

Potential Outcomes Measurements

  • Learners’ reactions

  • Modification of learners’ attitudes

  • Learners’ acquisition of knowledge or skills

  • Learners’ behavioral change

  • Change in organizational practice

  • Benefits to patients

Most common outcomes

measured for

professional students


Summary of lessons learned offered by students

Summary of Lessons Learned (offered by students)

  • Interdisciplinary cooperation does work!

    • Value of different professional perspectives

  • Blaming doesn’t accomplish much

  • “Obvious” problems aren’t always that Obvious

  • There is a systematic way to change systems

  • Don’t bring a knife to a gunfight


Summary of lessons learned offered by students1

Summary of Lessons Learned(offered by students)

  • Small changes in process flow can result in substantial benefits

  • Some problems are simply beyond your ability to control (Macro Issues)

  • There is no “I” in “TEAM”


Safety competencies after ip curriculum in safety quality 2007

Safety Competencies after IP Curriculum in Safety/Quality - 2007

* At the p < 0.05 level


Post training differences 2006 vs 2007 understanding of other professions

Post-training Differences – 2006 vs. 2007 Understanding of Other Professions

p = NS

p < 0.001

% of respondents from each discipline agreeing with statement:

“Involvement of multiple health care disciplines for quality and safety training enhances understanding of different

professional perspectives”


Post training differences 2006 vs 2007 understanding of other professions1

Post-training Differences – 2006 vs. 2007 Understanding of Other Professions

p < 0.001

% of respondents from each discipline agreeing with statement:

“Involvement of multiple health care disciplines for quality and safety training enhances understanding of different

professional perspectives”


Post training differences 2006 vs 2007 teamwork skill development

Post-training Differences – 2006 vs. 2007Teamwork Skill Development

p = NS

p < 0.001

% of respondents from each discipline agreeing with statement:

“Interprofessional learning is an effective strategy for

teamwork skill development”


Post training differences 2006 vs 2007 teamwork skill development1

Post-training Differences – 2006 vs. 2007Teamwork Skill Development

p < 0.001

% of respondents from each discipline agreeing with statement:

“Interprofessional learning is an effective strategy for

teamwork skill development”


Message from ip curriculum 2007

Message from IP Curriculum 2007

  • “Teaching” teamwork is neither engaging nor effective

  • Creating an environment conducive to teamwork, and structuring a task that demands teamwork, is effective in development of team skills.


Achieving competence today act

Achieving Competence Today (ACT)

  • Curriculum in QI/patient safety, developed by Partnerships for Quality Education (PQE)

  • 2004-2005: 12 schools used curriculum for interprofessional learners

  • 2005-2006: 13 schools participated

  • 2006-2008: 6 schools funded by RWJF


Act 2007

ACT 2007

  • Interprofessional model for experiential learning of quality improvement

The Internal Med Team

One

MSN student

One

pharmacist

Two inpatient

nurses

Four “integrated”

residents

Two attending

physicians


Act timeline

ACT Timeline

1st Learning

Session

2nd Learning

Session

3rd Learning

Session

Project

Presentations

October November December January February March

2006 2007


Act timeline1

ACT Timeline

1st Learning

Session

2nd Learning

Session

3rd Learning

Session

Project

Presentations

Ongoing Project Work and Experiential Learning

October November December January February March

2006 2007


Learner feedback

Learner Feedback

Mean score of respondents to statement that the ACT experience helped

them to develop greater teamwork skills or QI Skills

1 = Strongly disagree to 5 = Strongly agree


Learner feedback1

Learner Feedback

Mean score of respondents to statement that the ACT experience helped

them to understand the contributions made by other professionals and who felt the IP team was an important contributor to the value of ACT

1 = Strongly disagree to 5 = Strongly agree


Tracking outcomes act

Tracking Outcomes - ACT

  • Outcomes being analyzed:

    • Educational: Learner evaluations

    • Attitudes regarding other professions

    • Knowledge assessment (QIKAT)

    • Clinical outcomes of projects


Act lessons learned

ACT – Lessons Learned

  • Learning and patient care can be optimized simultaneously.

  • Health care learners bring key insights into the process of improving care.

  • Synergy is produced when we combine:

    • The idealism of health professionals in training with…

    • The realism of seasoned health care workers…

    • In the process of improving care


History of crm training at mu

History of CRM Training at MU

  • First class – May, 2003

  • Since then, appx 1200 trained

  • Feedback very positive


Bringing crm concepts to life at umhc

Bringing CRM Concepts to Life at UMHC

  • Med-Neuro ICU AM Pre-briefs

  • Time Out Check-list for OR


Safety tool implementation

Safety Tool Implementation

  • Standardized nurse-to-nurse reports in ICUs

  • Pre-catheterization checklists

  • Post-cath handoffs from cath lab to floor


Safety tool implementation1

Safety Tool Implementation

  • One minute nurse-physician phone huddle for Family Medicine admits


Educating for quality what are the barriers

Educating for Quality – What Are the Barriers?

  • Scheduling

  • Diversity of students and needs

  • Varying levels of clinical exposure

  • Lack of emphasis on current licensing exams

  • Lack of trained faculty

  • Competing demands on clinical staff

  • More opportunities than time


Faculty development

Faculty Development

  • Faculty champions needed at all levels of curriculum to succeed

  • Multiple concurrent efforts to advance faculty skills in quality/safety:

    • Revamping of M&M Conferences

    • Quality & Safety “Fellowships”

    • Quality Leadership Development Course planned for Fall, 2007

    • IHI Health Professions Collaborative


Educating professionals to improve health care

IHI Health Professions Education Collaborative

  • Founded in 2002

  • Mission – “Committed to the creation of exemplary learning and care models that promote the improvement of health care through both discipline-specific and interprofessional learning experiences.”


Educating professionals to improve health care

U Cincinnati

U Connecticut

U Chicago

U Nebraska

U Illinois

U Indiana

U Minnesota

U Missouri

U Louisville

Case Western U

Michigan State

U Manitoba

U Miami

UNC Chapel Hill

U South Florida

U Tennessee Memphis

Vanderbilt Univ

Oregon U

Dartmouth U

Lehigh Valley

Mayo Clinic

IHI Health Professions Education Collaborative


Educating professionals to improve health care

Involves schools of medicine, nursing, health administration, pharmacy and health professions.

Meets twice yearly for learning and sharing

Engages national health care leaders to promote education about work of improvement

IHI Health Professions Education Collaborative


How do we educate for quality1

How Do We Educate for Quality?

  • Key Concepts

    • Integrate material into curriculum to foster gradual increase in expertise

    • Connect to the care of patients

    • Assess outcomes

    • Offer interprofessional learning opportunities


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