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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. - PowerPoint PPT Presentation
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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, PhDNino 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
Pre-test (percentage of correct answers)
Post-test (percentage of correct answers)
Improvement0%
10%20%30%40%50%60%70%80%90%
100%
28%
51%
23%
Students -2013
Results
Pre-test (percentage of correct answers)
Post-test (percentage of correct answers)
Improvement0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
37%
64%
27%
PhD students -2014
Comparison of TEST RESULTS
0%
20%
40%
60%
80%
100%
28%
51%
23%
Students -2013
0%30%60%90%
37%64%
27%
PhD students -2014
Results
47%
35%
13%
2%3%
Course evaluation by Students - 2013
very goodgoodfairpoorvery poorno response
Results
62%
36%
20%
Course evaluation by PhD students - 2014
very goodgoodfairpoorvery poorno response
Comparison of EVALUATION
62%36%
20%
PhD students - 2014
very goodgoodfairpoorvery poorno response47%
35%
13%
2% 3%
Students - 2013
very goodgoodfairpoorvery poorno response
Results Suggestions about particular topics – PhD 2014
0%10%20%30%40%50%60%70%80%90%
100%100%
80%
40%
20%
40%
20%
60%
80%
60%
100%
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!
D4: Bridging the gap between undergraduate and postgraduate education
Jo-Inge Myhre, MD and Jessica Perlo, MPH
19th Annual International Forum on Quality and Safety in Healthcare
This presenter has nothing to disclose
April 10, 2014
Open School
Meet Dan
Took Courses & Created a Chapter
IHI Open School working group
Motivated and passionate volunteers
Weekly meetings
28
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
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
31
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: CLABSITeam 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)
Novice
(Advanced Prelicensure Learner)
Advanced Beginner
(Beginning Postlicensure Learner)
Competent
(Advanced Postlicensure Learner)
Proficient Expert
Student
Resident/Trainee/Junior Doctor
Faculty
QI Educator
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(Beginning Prelicensure Learner)
Novice
(Advanced Prelicensure Learner)
Advanced Beginner
(Beginning Postlicensure Learner)
Competent
(Advanced Postlicensure Learner)
Proficient Expert
Student
Resident/Trainee/Junior Doctor
Faculty
QI Educator
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
1. Health system culture embraces the idea that residents and junior doctors are critical to quality and safety.
2. Engaged, capable faculty are willing to mentor.
3. Training projects are aligned with quality and safety institutional goals.
4. Early student exposure to QI concepts can create champions and a pathway for application once they enter the delivery system
5. Ongoing, experiential learning opportunities allow deep practice.
“Advance health care improvement and patient safety competencies in the next generation of health
professionals worldwide.”
IHI Open School Mission
The IHI Open School
Curriculum Content
Experiential Learning
Community Networks
• 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
IHI Open School Courses
Certificates
Certificate of Completion
30 contact hours available for nurses, physicians, and pharmacists
200,000+ students, residents, and professionals638 Chapters in 67 countries167 Chapters (26%)
are located in hospitals or health systems
Community
Allied Health Pro-fessions
Business
Dentistry
Engineering
Health Sci-ence & Ad-
ministrationLawMedicine
Nursing
Occupa-tional & Physical Therapy
Pharmacy
Physician AssistantSocial Work
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
Quality Improvement Practicum (QI201)
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 openschool@ihi.org
Follow us on Twitter@IHIOpenSchool
Like us on Facebook Download our App
• What’s happening in your organisation at the moment in terms of quality improvement and safety training programmes
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
3 Behaviour
2 Learning
1 Reaction
Results for the organisation: quality, efficiency, productivity
Change in behaviour (knowledge/skills applied on the job)
Increase in knowledge, skills or attitudes?
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
Lack of tools to assess QI
knowledge & skills (level 2)
PLUS control group
Difficulties measuring behaviour
change (level 3)
Demonstrating benefits to
patients/organisation (level 4)
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
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