linda a. headrick, md, ms, facp february 26, 2013
TRANSCRIPT
Linda A. Headrick, MD, MS, FACPFebruary 26, 2013
Describe the rationale for integrating improvement into the medical school curriculum
Explore how health professional schools can innovate to emphasize quality improvement as a fundamental physician skill
What factors were present that helped make that happen?
SafeTimely
EffectiveEfficient
EquitablePatient-
CenteredIOM 2001
deliver patient-centered care
as members of an interdisciplinary team,
emphasizing evidence-based
practice,quality improvement
approaches, and informatics
IOM 2003
Habits of inquiry and improvementEngage learners in challenging problems and allow them to participate authentically in inquiry, innovation, and improvement of careEngage learners in initiatives focused on population health, quality improvement, and patient safetyLocate clinical education in settings where quality patient care is delivered, not just in university teaching hospitals
Cooke, Irby, O’Brien & Shulman 2010
Teaching for Quality (Te4Q)
Embed quality improvement & patient safety
across the continuum of
medical education
www.aamc.org/te4q
Te4Q Goal
Ensure that every medical school and teaching hospital in the U.S. has access to
a critical mass of faculty that are ready, able and willing to engage in, role model
and lead education in QI/PS
% US SOM Reporting IOM Goals
Academic Med Suppl Sept 2010
Interprofessional Faculty Development Institute for Quality Improvement and Patient Safety
Important Update: The 2013 IPEC Faculty Development Institute has reached maximum capacity. Please complete the Waitlist Form
Health Affairs 2012
“Retooling” Expectations• Create a medical/nursing school partnership• Secure support from academic and health system
senior leadership• Integrate quality improvement and patient safety
into core curricula• Engage students in hands-on improvement work
in partnership with a health care partner• Test changes in iterative cycles• Participate in collaborative support activities
Retooling for Quality and Safety• Case Western Reserve University • Johns Hopkins University• Penn State University• University of Colorado• University of Missouri• University of Texas Health Sciences Center,
San Antonio
Changes in Core Curricula
• 1374 student encounters• 87% interprofessional• Innovations in the– Classroom– Simulation center– Clinical setting
Innovations in the Classroom
• Large group– Penn State: Team-based learning to analyze a
medical error and recommend system changes– CWRU: Interprofessional quality “Grand Rounds”
with poster session, & structured reflection
• Small group– San Antonio: Weekly interprofessional QI seminar
Innovations in the Simulation Center
• Interprofessional communication & teamwork– Johns Hopkins & CWRU: SBAR– Colorado: TeamSTEPPS
• Interprofessional work around specific clinical issues– Colorado: Sepsis bundles in ICU– Missouri: Falls prevention
Innovations in the Clinical Setting
• Involving students in clinical QI– CWRU (nursing)– Colorado (nursing & medicine)
• Involving students in patient safety– San Antonio: Collected data about hand-washing– Missouri: Individualized patient falls prevention
Clinical QI at Colorado• UCH: student identified interprofessional
clinical issues• Prevention of Patient Falls• Patient-Centered Communication Using
Whiteboards • Improving ICU to Unit Transitions• Prevention of Decubitus Ulcers• Improving Discharge Process
• CHCO: on-going hospital-based project• Improving use of Patient Identifiers• Handoff Communication• Hand hygiene
Outcomes at Children's Hospital CO (over 2.5 years)
• 158 nursing students completed the experience
• 34 medical students completed the experience
• 1716 hours of work on hospital QI projects–Collection of over 16,000 data points
• 30% reduction in patient identification errors for 2011
Continuum of Education in Quality and Safety
Able to deliver effective patient-centered care
Honest with high ethical standards Knowledgeable in biomedical sciences,
EBM, and social/cultural issues Critical thinkers; problem-solvers Able to communicate Able to collaborate Committed to improving quality and safety Committed to life-long learning and
professional formation
MU SOM Continuum in Quality and Safety
“Medical students proposed safety interventions that were more robust
than those suggested by event reporters regarding similar
events within our health system (p<0.0001).”
Independent Online Modules on Patient Safety, QI and Fall Risk Reduction
Interprofessional Simulation: Preventing Falls in Hospitalized Patients
Bedside Fall Risk Assessment by Student Dyad& Customized Patient Education Plan
Interprofessional Debrief
Retooling for Quality and Safety
QMHC 2009
0
2
4
6
8
10
12
2006-2007 2007-2008
Mean quality improvement skill level measured by QI Knowledge Assessment
Tool (QIKAT)
Precourse-participating medical students
Postcourse-participating medical students
Postcourse-control medical students
prec
ours
e Q
IKA
Tno
t off
ered
'06-
'07
Meaningful integration into required curricula
AssessmentCritical mass of prepared facultyExemplary care for patients and
exemplary learning for health professionals
ExperientialClinically relevant
Evaluated
www.aamc.org/te4q
1. Reaction2. (a) Modification of attitudes/perceptions(b) Acquisition of knowledge/skills 3. Behavioral change4. (a) Change in organizational practice(b) Benefits to patients/clients.Adaptation of Kirkpatrick (1967)
by Barr et al , 2005
Expert educators to
create, implement, and evaluate training and
education in QI/PS for students, residents and
colleagueswww.aamc.org/te4q