Outcomes

Tier 2 – PI-LDP Course

Tier 3 – ATP or mini-ATP Tier 1 – ACT Program Three Tiers of QI TrainingAbstract

DEVELOPMENT OF FACULTY MENTORS IN QUALITY IMPROVEMENT ANDDEVELOPMENT OF FACULTY MENTORS IN QUALITY IMPROVEMENT ANDPATIENT SAFETY – A TIERED APPROACH FOR FACULTY ENGAGEMENTPATIENT 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

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. Eighty-six 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.

•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.

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.

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.

Tier 1

“Achieving Competence Today” QI Training Course

Tier 2

PI Leadership Development Course

Tier 3

ATP or mini-ATP Course

Common Elements ofAll Three Programs

Experiential training in QI, with participants completing a QI project which addresses a real health care delivery concern within our health systemLarge group educational sessions teaching QI principles that can be applied to the projectQI experts available to mentor participantsInterprofessional learning environmentRequirement for end-of-course presentation of project results

Cause and effect diagramsProcess flow chartingEstablishing appropriate metricsStakeholder identification and engagementChange management

Topics Covered:IOM aims for quality careUnderstanding quality gapDeveloping an aim statementCharacteristics of healthy teamsRoot cause analysisOvercoming barriers to change

•Provides 42 hours of classroom time•Improvement teams meet every one to two weeks

Topics Covered:Setting the stage for improvementUnderstanding process dependencyDeveloping an aim statementValue Stream mappingSpaghetti diagramsTeam formation, rolesOptimizing team performanceManaging team conflictSilent brainstorming and affinity diagramsTeam decision-makingRoot cause analysisIdentifying stakeholder issuesValue-driven health care

Run charts and control chartsPareto analysisCoaching teams to improve

careMeasuring work flowCause and effect diagramsEstablishing appropriate metricsFailure mode effects analysisUse of external data sourcesPI in practiceChange management skillsQuality transparency

•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 dateMost 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.