Quality and safety educational training programmes and how we evaluate them
Conflicts of interest • EkaterineRukhadze – none • Rob Bethune – none • Jane Runnacles – none • Jo-Inge Myhre – none • Jessica Perlo - none
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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. ClinicaChimica 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 • ImranQureshi. 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 Suggestions about particular topics – PhD 2014
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 partwas 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
19th Annual International Forum on Quality and Safety in Healthcare This presenter has nothing to disclose April 10, 2014 Open School D4: Bridging the gap between undergraduate and postgraduate education Jo-IngeMyhre, MD and Jessica Perlo, MPH
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
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 OS Courses OS Practicum IHI IA, VA Quality Scholar * 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 OS Courses OS Courses OS Courses * 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 Health system culture embraces the idea that residents and junior doctors are critical to quality and safety. Engaged, capable facultyare 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.”
IHI Open School Courses • 23online 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 200,000+ students, residents, and professionals 638Chapters in 67 countries 167 Chapters (26%) are located in hospitals or health systems
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
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