Embed Size (px)
DESCRIPTION
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 - PowerPoint PPT Presentation
Citation preview
Educating Professionals to Improve Health Care
April 12, 2007
Leslie W. Hall, MDUniversity 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
–Offer interprofessional learning opportunities
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
• 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 & Quality
2006
Medical students
Nursing students
MHA students
RT students
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• Attitudes and self-reported behaviors
around patient safety and quality assessed
• Knowledge – based exam
• Learner evaluations
Preclinical Clinical
Year 1 Year 2 Year 3 Year 4
Surveys completed:
Curriculum administered
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.
Comfort analyzing a case to find the cause of an error
1
2
3
4
5
Pre Post 1 Year Post
##
# = Significant Change
(Clinical clerkships)
1=Very Uncomfortable, 3=Neutral, 5=Very Comfortable
Madigosky W, et al. Academic Medicine; 2006
Adding a Safety “Booster”
Preclinical Clinical
PatientSafety
Curriculum
PatientSafety
Boosters
Year 1 Year 2 Year 3 Year 4
½ of class – No booster½ of class – Booster
1=Very Uncomfortable, 3=Neutral, 5=Very Comfortable
1
2
3
4
5
End 2nd Yr End 3rd Yr
No BoosterBooster
Comfort in analyzing a case to find the cause of an error…
p = 0.03
Interprofessional Curriculum
45 min intro lecture
6 Hours of small group work
Final presentation
2007
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
0 20 40 60 80 100
2007
2006
Medical
Nursing
MHA
Percent of students who valued the interprofessional nature of experience
Perceived Benefit to Career
0 20 40 60 80 100
2007
2006
Medical
Nursing
MHA
Percent of students who felt experience would benefit future career
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)
• 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 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
0%
20%
40%
60%
80%
100%
2006 2007
% of Safety SkillsImproved*
* At the p < 0.05 level
Post-training Differences – 2006 vs. 2007 Understanding of Other Professions
0%10%20%30%40%50%60%70%80%90%
100%
Pre -2006
Post -2006
Pre -2007
Post -2007
MedicalNursingManagement
% 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”
p < 0.001
p = NS
Post-training Differences – 2006 vs. 2007 Understanding of Other Professions
0%10%20%30%40%50%60%70%80%90%
100%
Pre -2006
Post -2006
Pre -2007
Post -2007
MedicalNursingManagement
% 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”
p < 0.001
Post-training Differences – 2006 vs. 2007Teamwork Skill Development
0%10%20%30%40%50%60%70%80%90%
100%
Pre -2006
Post -2006
Pre -2007
Post -2007
MedicalNursingManagement
% of respondents from each discipline agreeing with statement:“Interprofessional learning is an effective strategy for
teamwork skill development”
p < 0.001
p = NS
Post-training Differences – 2006 vs. 2007Teamwork Skill Development
0%10%20%30%40%50%60%70%80%90%
100%
Pre -2006
Post -2006
Pre -2007
Post -2007
MedicalNursingManagement
% of respondents from each discipline agreeing with statement:“Interprofessional learning is an effective strategy for
teamwork skill development”
p < 0.001
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)
• 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• Interprofessional model for experiential
learning of quality improvement
Four “integrated” residents Two attending
physicians
Two inpatientnurses
One pharmacist
One MSN student
The Internal Med Team
ACT Timeline
October November December January February March 2006 2007
1st Learning Session
2nd Learning Session
3rd Learning Session
ProjectPresentations
ACT Timeline
October November December January February March 2006 2007
1st Learning Session
2nd Learning Session
3rd Learning Session
ProjectPresentations
Ongoing Project Work and Experiential Learning
Learner Feedback
0 1 2 3 4 5
QI Skills
Teamwork
Nursing
Residents
Mean score of respondents to statement that the ACT experience helpedthem to develop greater teamwork skills or QI Skills
1 = Strongly disagree to 5 = Strongly agree
Learner Feedback
0 1 2 3 4 5
InterprofessionalAdded Value
UnderstandOther
Professions
Nursing
Residents
Mean score of respondents to statement that the ACT experience helpedthem 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
• Outcomes being analyzed:– Educational: Learner evaluations
– Attitudes regarding other professions
– Knowledge assessment (QIKAT)
– Clinical outcomes of projects
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
• First class – May, 2003
• Since then, appx 1200 trained
• Feedback very positive
Appropriateness of Training
83%
93%97%
86%
70%
80%
90%
100%
Agreed or strongly agreedthey had a need for CRM
training
Responded the trainingprovided them with
knowledge and/or skills
Responded the training wouldbe extremely or very useful to
reduce errors in practice
Reported the training has thepotential to increase patientsafety and quality of care
Bringing CRM Concepts to Life at UMHC
• Med-Neuro ICU AM Pre-briefs
• Time Out Check-list for OR
Safety Tool Implementation• Standardized nurse-to-nurse reports in
ICUs
• Pre-catheterization checklists
• Post-cath handoffs from cath lab to floor
Safety Tool Implementation
• One minute nurse-physician phone huddle for Family Medicine admits
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 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
• 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.”
IHI Health Professions Education Collaborative
• 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
• 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 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
