Approach to System Change: Teamwork and Plan-Do-Study-Act (PDSA) Cycles: team meeting using PDSA template as a guide to plan initial PDSA cycle (. Microsystem/Gap Analysis: brief didactic on process mapping and fishbone diagrams followed by 50 minutes of teamwork on initial drafts of each. You'll also want to dig up a few of your past nursing essay s, term papers, and case studies. Using that information, they work to identify areas of improvement and highlight areas of excellence, said Sowell. Sixty trainees (31 IM residents, 22 NP students, four pharmacy residents, and three psychology fellows) completed both the pre/post Quality Assessment and Improvement Self-Assessment surveys (25%, n = 60 out of 240; Tables 1 and and2).2). The aim of this quality improvement (QI) project was to increase OSA diagnosis to 5% from the baseline rate of less than 1% in patients with HTN between the ages of 18 and 75 years over a 6-month time period using the STOP-BANG sleep apnoea screening tool in IMC. Two very broad areas that are usually good for QI are designing and implementing a clinical pathway, or working to optimize the admission or discharge process. Quality Improvement (QI) is an evidence-based approach that helps primary care free up time to deliver and evaluate initiatives, and embed new approaches more effectively and efficiently into practice. The use of health IT can improve the quality of care, even as it makes health care more cost effective. Throughout the curriculum, the leadership team coordinated and coached mentors and teams via monthly emails and mentor meetings. 6 How do you use it? QI mentors (n = 23) observed growth in trainees' QI knowledge and skills, felt confident in trainees' ability to orchestrate a QI initiative, and believed their mentored QI projects added value to the organization. PowerPoint presentations to augment the lesson plans (. QIP Ideas The following ideas are taken from Quality Improvement Projects carried out by trainees in various parts of the country. See if you can get a couple viable nursing capstone project ideas. Quality improvement professionals review patient and other medical data and analyze processes used to provide care. I appreciated being able to bear witness to the growth in leadership skills within my team.. Trainees also had up to 1.5 hours weekly to work on QI-related activities. Quality Improvement and Person-Centeredness: This was a test of the "Always Event" concept, a method in healthcare settings in which you identify care issues that are important to patients and families and encourage medical providers to focus on those issues. In order to minimize survey burden, our CoEPCE program focused IP competency assessments within our clinical teams rather than our QI teams. We defined fully adopted projects as those where the systems change (e.g., process change, materials produced) implemented by the trainee team was sustained as of May 2019. practice management, quality improve-ment, small primary care practices. Ensuring patients receive care that is safe and of high quality is an essential part of modern healthcare. For clinical pathways, you could look at a common disease process and think about/design a way of standardizing an element of treatment or diagnosis. Thirty-eight IP teams' QI project work favorably influenced care processes (e.g., providing after-visit care summaries to patients, use of written opiate care agreements) that led to systems changes beyond the time frame of the formal curriculum. VI.A.1.b) (1) (a) Residents must receive training and experience in quality . . Secure network drive for QI teams' shared work. Increasing access to naloxone in Primary Care for patients on chronic opioid therapy, Implementation of integrated Behavioral Health in a rural Primary Care clinic, Reducing inappropriate prescribing of proton pump inhibitors in Primary Care, Increasing access to HIV prophylaxis in the Primary Care setting, Pharmacy directed outpatient gout management, Patient experience of shared medical appointments. You can also test your intervention in a graded fashion. A quality improvement project (QIP) should be a continuous process of learning, development and assessment, and part of a wider QI programme. Additionally, we recruited five NP residents to subsequently join our faculty, and they eventually became senior mentors. Results are presented at Grand Rounds in the spring. With this drastic evolution in practice, there was a steep learning curve. Fourteen mentors (54%) had 1 or 2 years of experience as a QI mentor; the rest had 3 or more years of experience (46%). They can also tackle very simple processes. Thus, an individual trainee assessment process would improve our ability to gauge each participant's achievement of the learning objectives and, consequently, potentially better address the trainees' unique learning needs and influence team dynamics. Rettberg L, Anderson D. Addressing polypharmacy via appropriate PPI prescribing. 2018;7(3):e000221. Our review of the 41 QI posters and team rosters showed that teams were multiprofessional, with a range of two to five different professions per team. This means that the patient's needs and preferences are known ahead of time and communicated at the right time to the right people, and that this information is used to provide safe, appropriate, and effective care to the patient. VI.A.1.b) (1) Education in Quality Improvement. Sites with limited faculty resources might consider designating a QI faculty champion from each profession instead of embedding multiple profession-specific faculty as team mentors. It will also be helpful in supporting the wider goals of GP Quality Clusters in Scotland andthe Scottish Patient Safety Programme. It comprises identifying a deficit in quality of care and aiming to improve, by making small cumulative changes and measuring their effects. Nineteen teams (46%) formally included staff as team members, including registered nurses, licensed vocational nurses, medical support assistants, pharmacists, and social workers. Integrating quality improvement with graduate medical education: lessons learned from the AIAMC National Initiatives. hbbd```b``"@$|L` ,~V_f$ r9HDoK$O = PBRNs engage clinicians in quality improvement activities and an evidence-based culture in primary care practice to improve the health of all Americans. Our IP QI curriculum for IM and pharmacy residents, nurse practitioner (NP) students, and psychology fellows working in a primary care clinic was implemented and continuously improved over 7 years as part of the San Francisco VA Health Care System's (SFVAHCS) Center of Excellence in Primary Care Education (CoEPCE) program. The importance of both prevention and . Prior to the initiation of these projects, participants completed an 8-hour QI training workshop led by the LiveWell Team at CareOregon and Malinda Burt MNE RN, a student in OHSU's MNE Graduate Program. This Quality improvement project aims to achieve the patient-centered healthcare goal, to help focus on high-risk populations like women in Menopause, and men with multiple comorbidities, and to address their emotional and physical stressors appropriately and timely. Internet Citation: Improving Primary Care Practice. The Pharmacist and Data-Driven Quality Improvement in Primary Care (P-DQIP) intervention aims to improve prescribing safety via an informatics tool, which facilitates proactive management of drug therapy risks (DTRs) by health-board employed pharmacists with established roles in general practices. There's no reason not to take . Dobson RT, Stevenson K, Busch A, Scott DJ, Henry C, Wall PA. A quality improvement activity to promote interprofessional collaboration among health professions students. Raffel KE, Beach LY, Lin J, et al. Similarly, application of these methods also provides important evidence of QI activity withinmedical appraisal, specialty training and continuing professional development more generally for clinicians and managers alike. Staff typically did not have formal QI training. In our project tracking record, we examined project impact by assessing improvements in processes and outcomes of care, as well as the products associated with each project (Appendix J). There may also have been a positive reporting bias, where authors were more likely to report their successful interventions and not include details of those PDSA cycles that were unsuccessful. Lockeman KS, Dow AW, DiazGranados D, et al. The GMC recommends that all doctors demonstrate an involvement in Quality Improvement at least once a year. Partially adopted projects included those in which some of the primary systems changes were adopted and other elements were abandoned and/or projects in which initial interventions were foundational but continued to be adapted by staff or other trainee teams. Challenges included reliably collecting evaluation data, accurately measuring ongoing systems changes, and variable trainee engagement. The programme will run for 15 months, including a recommended set up phase starting in October 2015. We are also limited in our direct assessment of individual trainees' knowledge and skills beyond self-reported comfort and confidence levels. Diaz VA, Carek PJ, Dickerson LM, Steyer TE. On average, trainees indicated slight to moderate comfort with most items prior to the QI curriculum and moderate to extreme comfort at the end of the curriculum. Residents also have the opportunity for advanced training in quality improvement methods and to pursue their own projects through the course of their training. mentality. All teams (n = 41) acknowledged on their posters at least one contextual factor that favorably influenced or posed a significant barrier to project selection, implementation, and/or future sustainability. Naloxone distribution and training for patients with high-risk opioid use in a Veterans Affairs community-based primary care clinic. Quality improvement is a fundamental component of nursing care. From academic years 20112012 to 20172018, 149 IM residents and 52 NP students completed the curriculum. 2015-2022 | University of Washington | Seattle, WA. The program is aligned with the Pediatric Residency Review Committee requirement that all residents learn QI methods and participate in a QI project during their residency. This is an open-access publication distributed under the terms of the Creative Commons, Quality Improvement, Interprofessional Education, Nursing, ACGME CLER Programs, Nurse/Nurse Practitioner, Pharmacist, Physician, Psychologist, Curriculum Development, Quality Improvement/Patient Safety, MedEdPORTAL : the Journal of Teaching and Learning Resources, Clinical Prevention and Population Health Curriculum Framework: Version 3. To promote stronger engagement, AHRQ is developing a guide to help patients, families, and health professionals in primary care settings work together as partners to promote improvements in care. Basics of Quality Improvement. [] In response, private sector payers and Medicare are restructuring reimbursement . Comparable to the IP QI curriculum depicted by Hunt and colleagues, we created an experiential QI curriculum for primary care trainees that drew on best practices from profession-specific QI curricula,1,12,18,21,3747 and our experiences as QI and IP educators. Quality improvement projects in healthcare or, more specifically, in nursing can analyze and improve complicated processes. Activities to promote team formation and cohesion included establishing and observing ground rules and beginning all sessions with check-ins to share personal and professional background and interests.59 Teams and mentors then met twice per month to work on project implementation. We also formally recruited staff to join the teams. . We also recommended that trainees complete several IHI Open School online courses concurrently to reinforce key QI concepts.42. Andrea Mosher, CPNP is a suburban emergency room RN turned rural primary care pediatric NP. The disease and its associated comorbidities impact health of patients and increase healthcare costs. The meeting format was coordinated by the mentors and predicated on work completed to date. Reed D, Wittich C, Drefahl M, McDonald F. A quality improvement curriculum for internal medicine residents. Agency for Healthcare Research and Quality, Rockville, MD. Residents are eligible for protected time for individual quality improvement and research projects. Programs adopting this model should be attentive to concerns about ownership of the project and how staff's involvement influences the trainees' learning experience. The purpose of this project was to examine medication reconciliation compliance in an intensive care unit (ICU) at a Midwestern hospital and implement a pilot quality improvement (QI) project. Telephone: (301) 427-1364. The curriculum co-directors and two senior faculty mentors completed TeamSTEPPS training53 to learn teamwork skills and principles. You may switch to Article in classic view. 2019. Examples of prior quality improvement and research projects: Increasing access to naloxone in Primary Care for patients on chronic opioid therapy Implementation of integrated Behavioral Health in a rural Primary Care clinic Reducing inappropriate prescribing of proton pump inhibitors in Primary Care Each member spent an additional 24 hours monthly on curriculum planning. Engaging in quality improvement enables clinicians to acquire, assimilate, and apply important professional capabilities7 such as managing complexity and training in human factors.1 For clinical trainees, it is a chance to improve care9; develop leadership, presentation, and time management skills to help their career development10; and build relationships with colleagues in organisations that . %PDF-1.7 % The average monthly mentor commitment was 4 hours: 2 hours of team meetings, a 1-hour mentor meeting, and 1 hour of consultation with team members or stakeholders. The authors report no conflicts of interest. The staff may be able to more quickly advance an intervention because they are full time in the clinical setting. We calculated descriptive statistics for each item. The Quality Improvement Project (QIP) is a constituent of Workplace Based Assessment (WPBA), one of the three parts of the MRCGP examination. University of Minnesota School of Nursing has defined the DNP project as: Student identification of a systems based, quality improvement problem in health care Implementation of an evidence-based solution to address the problem Evaluation of process and outcome objectives of the project Completion of a paper that describes the project and outcomes. We added three items to assess attitudes toward QI, confidence in ability to make change, and perceived opportunity to apply QI skills, each rated on a 5-point scale (1 = strongly disagree, 5 = strongly agree). Introduction. The positives of staff involvement include diversity of perspective and expertise, involvement of potential process owners, identifying sustainable champions, and promoting the identity of staff as teachers. Many studies have demonstrated that high-quality mental and behavioral health care may often be delivered in primary care settings. The newsletter emails (Appendix F) provided logistics and just-in-time QI education. hb```!b`f`s\Pk? These included histograms (n = 24), Pareto charts (n = 2), pie charts (n = 17), process maps (n = 11), and run charts (n = 13). Keywords. IM residents rotated monthly between outpatient and inpatient rotations during which they did not participate in QI team activities. To make things easier, this resource describes several QI methods that will be useful for all members of the primary care team, including GP specialty trainees, who wish to better understand and apply QI thinking and tools more effectively. Clinical-community linkages help to connect health care providers, community organizations, and public health agencies so they can improve patients' access to preventive and chronic care services. 2014;62(2):7888. The authors wish to acknowledge all the quality improvement mentors and staff who have contributed to the interprofessional quality improvement curriculum at the San Francisco VA Health Care System. Trainees rated the overall quality of QI sessions as very good to excellent (M = 4.4, SD = 0.7, n = 429, approximately 36% response rate based on five introductory sessions with 240 trainees). It is through your collective efforts that this curriculum continues to be a vital component of the quality initiatives in the San Francisco VA Health Care System. QI leadership team members and mentors had variable training and background in QI and IP teamwork. Demonstrating the positive impact of the curriculum on patient care and developing QI expertise of faculty and staff could help others adopting this curriculum build a compelling argument to secure needed resources.69. Including staff who are also in a learning stage can have an additional sustained benefit to the clinical learning environment. Accessed December 28, 2018. Need help getting started? Trainees generally appreciated staff being part of the QI teams and felt their involvement favorably influenced project impact and sustainability. Core Competencies for Interprofessional Collaborative Practice: 2016 Update, CLER 2016 National Report of Findings. QI teams' formal 1-hour meetings occurred during the trainees' typical outpatient didactic time. https://doi.org/10.7812/TPP/17-179, Upadhyay V, Walker E, Govea A, et al. Other than giving the project synopsis (Apprendix K), reporting these outcomes in detail was beyond the scope of this report as each project had its own context, methodology, and both qualitative and quantitative results. 3. Upon completion of the workshop, Malinda . Quality Improvement in healthcare is the specific framework used to systematically maximize or improve the level of care delivered to patients at healthcare facilities. Sites without an established IP training program can apply our curriculum to teams of physician residents and IP staff. Performance Measures and Facility Quality Gaps: a 40-minute didactic and 20-minute facility data review to learn about quality measurement and identify potential project ideas. It differs from clinical audits in that audits test practice . Mentors highlighted several challenges, such as finding the optimal level of involvement, particularly when mentors gave substantial guidance and had more direct involvement to keep the project moving along. Mentors also noted the complexity of involving staff as collaborative partners, balancing encouraging staff to take action without taking away somewhat from trainees' learning and ownership of the QI project and potentially reducing trainee buy-in. Mentors mentioned the IM resident schedules (alternating months in clinic) as sometimes challenging for project momentum and trainee engagement. Agency for Healthcare Research and Quality; Updated July 2018. (26 Jpy d` @,`tb`h`8q'S62F3[ocTb'7sMp30g4L But engaging in care redesign is challenging for clinicians. Primary care providers have the potential to proactively address weight management. Extended Examples of Quality Improvement Projects in Adult Immunization These extended examples will highlight the Residency Clinic and the Private Practice as vaccination settings. Upon completion of the quality improvement (QI) curriculum, trainees will be able to: As health care systems embrace quality improvement (QI) as a key element of practice, health professions educational programs aim to prepare trainees capable of participating in QI initiatives as part of their routine practice.16 As a result, many programs include QI projects as part of a required curriculum during clinical placements.711, There is a potential added benefit in interprofessional (IP), experiential QI learning. Evidence in the literature supporting the change. Blue Care Network Of Michigan's quality improvement plan was developed to help realize its mission of providing members with affordable, innovative products that improve their care and health. Attention to team-building and a safe learning climate may be especially important if working in an IP group is novel and team members have not formed relationships.63,67,68, Since our curriculum was embedded in a funded IP VA CoEPCE, we likely had more resources and access to data than typical training programs. Kaplan HC, Froehle CM, Cassedy A, Provost LP, Margolis PA. An exploratory analysis of the Model for Understanding Success in Quality. [1-3] It is also evident that higher cost does not equate to better care. The demand from the healthcare system on providers such as nurse practitioners appears to be growing daily. They also reported improvement in comfort with QI knowledge and skills by the curriculum's completion. PBRNs engage clinicians in quality improvement activities and an evidence-based culture in primary care practice to improve the health of all Americans. Time and resources: Enlist a dedicated cadre of clinicians and other staff members to lead QI work,. A tip for success: Develop and implement your . Methods We included . Students' projects must: Enhance health outcomes, practice outcomes, or policy outcomes Evaluate health care outcomes, practice outcomes, or policy outcomes Reflect a culmination of practice inquiry Engage in new partnerships Reflect a translation of evidence into practice Interprofessional primary care electronic intervention to reduce hypoglycaemic agent use in high-risk veterans with diabetes. Veteran Affairs Centers of Excellence in Primary Care Education: transforming nurse practitioner education. Competencies for Psychology Practice in Primary Care. Primary care is the cornerstone of health care that is effective and efficient and meets the needs of patients, families, and communities. Twenty-two pharmacy residents and 17 psychology fellows have completed the curriculum since 2013. These experiences include: Teaching basic principles of continuous quality improvement (QI), individual performance improvement, patient safety and safety event analysis, teamwork and the culture of safety for interns . Patel S, O'Brien BC, Dulay M, Earnest G, Shunk RL. Improvement approaches may focus on quality of care within each microsystem; however, to improve the patient journey, consideration should also be given to the interface between microsystems. Appropriate workflows can also reduce the incidence of provider burnout, as providers know what to expect for the workday and can prepare accordingly. The Kirkpatrick four-level model of program outcomes informed the design of our evaluation approach.54,63. The Quality improvement project on educating primary care providers about . Leadership members identified institutional quality gaps and priority project themes (Appendix E) via review of facility performance data and input from clinic leadership and other key stakeholders. Interprofessional Education Collaborative. Clearly stated ground rules, reflection on team function during meetings, and meeting minutes enhanced oral and written communication skills, respectively. Institute for Healthcare Improvement. We are experimenting with display styles that make it easier to read articles in PMC. This approach enables you to implement and trial small scale ideas quickly with minimal disruption to patient care. Trainees were second-year adult gerontology primary care NP students, and second-year IM residents serving as primary care providers in their assigned clinics 3 half-days per week. Accelerating performance improvement in primary care: a practice-based interprofessional (IP) curriculum. Our primary care system currently has significantand perhaps unprecedentedopportunities to emphasize quality improvement (QI) and practice redesign in ways that could fundamentally improve health care in the United States. Demonstrate an ability to apply QI knowledge and skills. Additionally, we obtained information regarding project impact from a mentor survey. Pharmacy and clinical psychology faculty also provided input. Educators can apply this content to implement an IP QI curriculum for trainees and/or staff in primary care or other continuous care sites. hkkJ~/F;;{;-CN~P;!}wWvTNP. One mentor commented, It was great to see what a team could accomplish in a short amount of time. Primary care practice-based research networks (PBRNs) are groups of primary care clinicians and practices working together to answer community-based health care questions and translate research findings into practice. . Other mentors were past graduates of our CoEPCE curriculum, had completed 1 year of the VA Quality Scholars program, or had completed the 1-week VA Quality and Safety Chief Resident boot camp. Building quality improvement capacity in primary care. There are many quality improvement activities that take place in general practice, including audit, significant event analysis, analysing prescribing and referral data, and the Quality and Outcomes Framework. We designed an experiential, longitudinal (9-month) QI curriculum for IP teams working in a primary care setting. Introduction to QI: a 1-hour didactic overview of QI curriculum structure, QI methodology, and commonly used tools. Our IP QI curriculum required the following resources: The QI leadership team completed activities throughout the year to prepare, facilitate, deliver, and evaluate the curriculum. Research shows that when patients are engaged in their health care, it can lead to measurable improvements in safety and quality. All Core Medical Trainees in the East of England are required to complete one Quality Improvement Project in each of their training years, as specified in the ARCP decision aid. Acknowledge contextual factors that can influence QI projects. Our mentorship structure was purposely designed for each team to have more than one mentor, ideally from more than one profession. The authors alone are responsible for the writing and content of this paper. The back of the card includes a list of information patients should provide when leaving a message at the clinic. Some people question why providers, clinics, and hospital systems even worry about quality improvement, as they perceive it as "fixing what isn't broken." Initiatives: 5 Million Lives Campaign. The UNC Pediatric Residency Quality Improvement (QI) Program is designed to help prepare pediatricians to address quality of care issues during their training and career. Trainees rated the match between the content discussed during the session and their learning needs being met as very good to excellent (M = 4.5, SD = 0.7, n = 112; asked only in 20162017 and 20172018; Table 1). Background The University of California, San Francisco, Institutional Review Board and the VA Office of Research & Development approved this study. Accessed January 27, 2019. The prevalence of type 2 diabetes mellitus (T2DM) has increased substantially in the United States in recent years. It is an evidence-based approach that helps primary care free up time to deliver initiatives and embed new approaches more effectively and efficiently into . A variety of approachesor QI . These examples are provided to illustrate the practice improvement process, and that actual efforts devised by physicians and their team may differ based upon The functionality is limited to basic scrolling. The mentors surveyed also agreed that projects they mentored enhanced the trainees' knowledge and skills in QI (M = 4.2, SD = 0.8; Table 3). A review of the notes you've written throughout the semester gets your brain spewing out great ideas. 138 0 obj <> endobj Contact Health Catalyst today! Primary care is often underutilized for depression screening, and it is not clear how practices can successfully increase screening rates. Lead. The selected projects will be led by clinical teams and will develop their innovative ideas and approaches, put them into practice and gather evidence about how their innovation improves quality. Practice improvement modules programs, 20042010. RELATED: New Graduate Nurse Practitioners: Keep Learning to Build Confidence. While using more faculty resources, this increased the opportunity for trainees to observe role models within their own profession and from other professions. Perm J. Mentors favorably viewed the impact of the QI projects, endorsing the statement that the QI projects they mentored added value to the medical center (M = 4.4, SD = 0.7) and agreeing that clinic staff were contributing members to these projects (M = 4.0, SD = 1.1; Table 3). While the ultimate goal of a healthcare system is to create high-quality and high-value care for its consumers, most of the responsibility ultimately falls on the physicians, nurse practitioners, physician assistants, nurses, and support staff. Quality Improvement (QI) is a commitment to continuously improving the quality of healthcare by focusing on the preferences and needs of the people who use the services. The formal curriculum took place over 9 months each academic year (20112012 through 20172018) beginning in September to allow almost all trainees to have at least 3 months experience working in the clinical setting. The ePub format uses eBook readers, which have several "ease of reading" features Creating change: an experiential quality improvement and patient safety curriculum for medical students. While we appreciate the strengths and accomplishments of our curriculum, we do recognize its limitations. Health Center Program Quality Improvement initiatives align with the National Quality Strategy and support the efforts of health centers toward:. Most completed Institute for Healthcare Improvement (IHI) Open School online courses42 and Lean yellow or green belt training52 to attain a common set of knowledge and skills. Hunt LM, Fisher AK, King I, Wilper A, Speroff E, Weppner W. Primary care collaborative practice in quality improvement: description of an interprofessional curriculum. At the same time, attempting to achieve these goals without a proper plan can be exhausting, expensive, and inefficient. Intervention: The Facing Diabetes Project offered medical visits for adults and provided prevention and education sessions for the local 4th and 5th graders. To learn more, email PrimaryCare@HQOntario.ca Almost all of the trainee QI projects reported positive outcomes and systems change by the end of the curriculum. Our results from project data (41 projects completed over 7 years by 240 participants with two to five professions per team), trainee surveys (increased reported confidence in QI knowledge and skills), and positive perceptions of the curriculum by trainees and QI mentors indicate that the curriculum leads to trainees' successful attainment of educational objectives and systems-level improvements. Background An unplanned extubation is the uncontrolled and accidental removal of a breathing tube and is an important quality indicator in pediatric critical care. Find out about upcoming events and local QI news in primary care (in development) Click on the resources below to see some examples Download all QI QI xlsx Telephone Triage Sheet qi example Size: 15.48 KB Hits: 252 Download Preview Useful clinical topics to audit in GP Practice Generating an ePub file may take a long time, please be patient. Rockville, MD 20857 Data sources included VA performance dashboards (n = 18), locally developed surveys (n = 8), chart reviews (n = 17), and/or data extractions from the regional or national data warehouses (n = 10). Each novice mentor (e.g., NP residents, Quality and Safety IM chief residents, and VA Quality Scholar fellows) was partnered with an experienced mentor. 171 0 obj <>stream Step 2: Plan and test - decide the aims, methods and monitoring of your change. The emergence of quality improvement (QI) and patient safety training in postgraduate medical education: an updated systematic review of QI and patient safety curricula, Veteran Affairs Centers of Excellence in Primary Care Education: transforming nurse practitioner education, CLER National Report of Findings 2018: Executive Summary. A staff member with knowledge of data sources (e.g., facility data warehouse or data dashboard tools) retrieved and helped analyze data for the projects. The test was conducted by the National Health Service in Lanarkshire, UK. Acknowledge contextual factors that can influence QI projects. For this reason, a stand-alone IP QI curriculum evaluation should include a quality assessment and improvement tool (e.g., Quality Assessment and Improvement Self-Assessment tool62), as well as instruments to assess team functioning (e.g., the Team Development Measure70) and IP competencies (e.g., Interprofessional Education Collaborative Competency Self-Assessment survey71) in the context of QI work. Our program size and duration helped in part to offset these limitations. During your application process, you'll present an idea for your community improvement project (DNP project). They can support trainees in their own profession by identifying profession-specific learning needs, promoting buy-in, and supporting conflict resolution. Health care/system redesign involves making systematic changes to primary care practices and health systems to improve the quality, efficiency, and effectiveness of patient care. Emergency Department quality improvement is a journey that takes time and improving ED performance is much more than an emergency department initiative-it must involve the entire system of care. Maya Dulay, MD, JoAnne M. Saxe, DNP, [], and Rebecca Shunk, MD. In the first month of the curriculum, we introduced core QI concepts and skills in 1-hour sessions. Gaps in the quality of medical care in the United States and evidence of significant variation in medical prac-tice are well documented. Now her daily role is based significantly on educating patients and families, so writing freelance health content just seemed to be the perfect fit to share her knowledge with patients and other healthcare workers. The objective of this review was to comprehensively synthesize literature published on quality improvement (QI) practices implemented to reduce the rate of unplanned extubations in critically ill children. The EHR allowed Ellsworth to efficiently examine key clinical data (e.g., blood pressures above the target threshold). Early in the second year, residents receive training in the Model for Improvement method. One mentor commented, I loved working with an interdisciplinary team. Another expressed appreciation for affecting my workplace in a positive manner and changing my clinical practice based off QI findings.. Facing Diabetes: Quality Improvement in Rural South Dakota Project Updated/reviewed May 2022 Need: To help adults and children in rural South Dakota prevent or manage their diabetes. Activities such as regular queries/check-ins about team members' role, interests, accomplishments, and challenges and mentor-guided IP teamwork were important for building cohesion and role clarity. More than half the teams referenced performance measures (e.g., percentage of patients with a glycohemoglobin less than 9% and 30-day hospital readmissions). Received 2019 May 2; Accepted 2020 Jan 17. The quality improvement (QI) project for better blood pressure control began in 2007 and was significantly enhanced in 2010 when the clinic implemented an electronic health record (EHR). Background: Small practices often lack the human, financial and technical resources to make necessary practice improvements and infrastructure investments in order to achieve sustainable change that promotes quality and efficiency. Other Participating Faculty. Teaching quality improvement in a primary care residency, A didactic and experiential quality improvement curriculum for psychiatry residents, Using Lean methodology to teach quality improvement to internal medicine residents at a safety net hospital, Connecting resident education to patient outcomes: the evolution of a quality improvement curriculum in an internal medicine residency, Practice-based evidence of evidence-based practice: professional practice portfolios for the assessment of work-based learning. Junior mentors often had more time and bandwidth to support their teams between meetings, allowing senior mentors to focus on sharing their QI, IP, and education expertise during team sessions. They prioritized potential project themes that had readily accessible data and/or invested stakeholders. Shunk R, Dulay M, Chou CL, Janson S, O'Brien BC. Quality improvement. This work is funded by the Department of Veterans Affairs, Office of Academic Affiliations, as a Center of Excellence in Primary Care Education. Quality Improvement examples in Mental Health Services Introduction: Little is known regarding how to accomplish large-scale health care improvement. Express confidence in applying QI processes and methods. During these meetings, mentors emphasized the importance of collaborative QI teamwork and contextual factors (external environmental, organizational, infrastructural, microsystem, and QI team factors) that could influence QI success.43,6062 Learning strategies included group discussions, shared leadership (i.e., rotating roles of meeting facilitator, scribe, and timekeeper), debriefs regarding project progression, and team meeting synopses via minutes.47,59 In the sixth month, the teams delivered work-in-progress presentations to their peers and mentors for the purpose of obtaining feedback to guide ongoing work. We aimed to give trainees realistic experiences to develop their QI and IP skills. QI Project Examples. A Quality Improvement Initiative to Improve Weight Management in Primary Care Obesity has become a major health problem. This paper describes a quality improvement project that aimed to establish consistent implementation of best practice in people with stage 3-5 kidney disease who were managed in primary care. Because mental health, behavioral health, and substance use disorders are among the most common conditions seen in primary care settings and frequently occur with other medical problems, primary care providers are often in the best position to identify, diagnose, and treat them. Our curriculum accomplishes the development of shared IP and QI competencies for health professionals and could be implemented in varied longitudinal inpatient or outpatient clinical training programs. already built in. Therefore, it is important to understand the purpose of quality improvement and how to effectively execute performance improvement programs. This multistep process systematically breaks down the process and allows for proper monitoring of progress: Primary care NPs can take the following steps to make concrete quality improvements in their offices: Continual monitoring of primary care workflow leads to efficient patient appointments and potentially better patient outcomes. The intervention was a Care Bundle for CKD. Hours per month varied depending upon the project. The sheet . Health Quality Ontario supports quality improvement in all primary care practice models. To advance the practice and employment of high-level nursing professionals by offering guidance on online educational and career opportunities specific to the nurse practitioner field. These are important factors for IP QI educators to consider when designing and evaluating their QI curricula. QI team mentorship was a requirement for a number of junior mentors, specifically, NP residents and MD chief residents, which insured a reliable mentor pool. Curriculum evaluation included trainees' QI knowledge and skills self-assessments, trainee satisfaction, mentor appraisals, and project results and impact assessments. The RCGP in However, for many, the experience of QI has often been felt to be "audit for audits sake" or a huge amount of work in an ever-increasing workload. Adult-Gerontology Primary Care Nurse Practitioner Competencies. Mentors used a 5-point scale (1 = strongly disagree, 5 = strongly agree) to rate each survey item. Changing the entire system of care . The program additionally supports scholarship in the form of clinical or public health research. Not-adopted projects included those that did not result in systems improvements or were deemed too resource intensive to continue. Dr. Hull's team wanted to improve the rate by 15 percent, so they sent letters generated through the electronic medical record to remind patients about the test. Kirkpatrick Partners. Teaching methodologies included didactics and project-based skills application. Care coordination involves deliberately organizing patient care activities and sharing information among all of the participants concerned with a patient's care to achieve safer and more effective care. Lastly, we created an integrated learning structure by teaching QI and team engagement content in sync with project work in a developmentally appropriate manner (Appendix C), which included access to IHI modules (average time for completion per module: 90 minutes) for trainees with less QI background to independently learn the basics via optional interactive online modules.42. Presented at: UCSF School of Nursing Research Days; April 2016; South San Francisco, CA. The Quality Improvement in Primary Care (QIPC) program is built on years of collaboration between SWSPHN and general practices to improve and maintain practice processes to meet regulated standards. Authors JoAnne M. Saxe and Maya Dulay analyzed project posters to assess the trainees' ability to apply what they had learned, for example, to (1) document aim statements, PDSA cycles, data sources, measures, and tools; (2) highlight influencing contextual factors43,62; and (3) acknowledge IP collaboration. Work with colleagues from multiple professions to design, implement, and evaluate a QI project. . https://www.ahrq.gov/ncepcr/tools/improve/index.html. Content last reviewed August 2019. Demonstrate an ability to apply QI knowledge and skills. In Table 4, we highlight the most commonly identified contextual factors and their respective effects on QI projects. The evaluation of our IP QI curriculum included (1) trainee satisfaction; (2) achievement of educational objectives; (3) impact on patient care, clinic systems, and stakeholders; and (4) QI mentor experiences and feedback. Trainee absences may lead to more direct involvement by staff and mentors, thus making it difficult to distinguish the amount of input on a project from trainees versus mentors/staff. Huddle-coaching: a dynamic intervention for trainees and staff to support team-based care. Also, the journal BMJ Open Quality is dedicated to QI projects and is easy to browse through or use the search bar. Wong B, Hollenberg E, Etchells EE, Kuper A, Levinson W, Shojania KG. In this workshop, learners were trained in improvement science and learned "how" to facilitate QI. AHRQ Projects funded by the Patient-Centered Outcomes Research Trust Fund. the display of certain parts of an article in other eReaders. We found debriefing about project progression and reflecting on achievements and challenges faced by different team members during team meetings and in meeting minutes allowed those who did not directly participate in a specific project task to still learn from the activity. Our experiential IP QI curriculum addresses this gap. Since 2016, all teams also completed an abstract. Trainees reported high satisfaction with the introductory sessions (M = 4.4, SD = 0.7). Twenty physicians (10 attending physicians, nine chief residents, and one senior resident), 27 NPs (including 17 NP residents), two pharmacists, and one psychologist served as QI mentors from 2011 to 2018. They are intended as a trigger for possible ideas, their inclusion . General Surgery, Vascular, Orthopedic (EUHM only), Thoracic (EUH only) The Plan Do Study Act (PDSA) approach is also recommended to help you choose an idea for a QI project. Accessed January 28, 2019. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. The integration of health information technology (IT) into primary care includes a variety of electronic methods that are used to manage information about people's health and health care, for both individual patients and groups of patients. The Kirkpatrick model. However, that is far from the truth. The estimated full-time equivalents of staff to organize and teach the curriculum are as follows: Quality and Safety IM chief resident: 0.05. RELATED: Keeping Your Sanity: How to Prevent Nurse Practitioner Burnout. While this is overall advantageous, it can reduce trainees' buy-in and engagement if they have less personal responsibility in day-to-day project success. The clinicians generated 10 tips to help guide QI efforts at primary care practices: 1. The redundancy also helped teams avoid mentorship gaps due to planned and unplanned mentor absences from sessions throughout the year. J., Meyers, D. (2013). Sixty-eight percent of teams were based at the main academic primary care clinic and 32% at one of two community-based clinics. Health professionals must demonstrate competencies in quality improvement (QI) and interprofessional (IP) practice. We used this model, for example, with pharmacy and pyschology faculty. A classic approach to the design and implementation of a quality improvement project is the Plan Do Study Act approach. Trainees rated their comfort with all 12 aspects of quality assessment and improvement as significantly improved. Forty-three percent of the projects' process changes and/or products were fully adopted, and 49% were partially adopted. However, continuously screening patients is imperative. The IP QI curriculum was part of a San Francisco VA Health Care System training program for second-year internal medicine residents and adult gerontology primary care nurse practitioner students, pharmacy residents, and postdoctoral psychology fellows. 155 0 obj <>/Filter/FlateDecode/ID[<777E0CB334595148B1908B06F60137C0><94C5FBE381AEEC489EA8D54864887D9C>]/Index[138 34]/Info 137 0 R/Length 92/Prev 223577/Root 139 0 R/Size 172/Type/XRef/W[1 3 1]>>stream The Center for Disease Control and Prevention defines quality improvement as"a continuous and ongoing effort to achieve measurable improvements in the efficiency, effectiveness, performance, accountability, outcomes, and other indicators of quality in services or processes which achieve equity and improve the health of the community." 13. To ensure these efforts are successful, there is a need to build and sustain the ability of primary care practices to engage in QI activities in a continuous and effective way. Poster presented at: National Organization of Nurse Practitioner Faculties (NONPF) Conference; April 1923, 2017; Washington, DC. We evaluated achievement of objectives via trainees' self-assessments (Tables 1 and and2),2), appraisals of the teams' posters (Table 1), and mentor perceptions of trainees' achievement of objectives (Tables 1 and and33). 4 Essential Projects to Improve Primary Care Office Flow for Nurse Practitioners, Adult-Gerontology Nurse Practitioner (AGNP), Psychiatric-Mental Health Nurse Practitioner (PMHNP), Nurse Practitioner Accreditation Organizations, Nurse Practitioner Licensing & Certification, Nurse Practitioner Salary By Specialty & State, Keeping Your Sanity: How to Prevent Nurse Practitioner Burnout, New Graduate Nurse Practitioners: Keep Learning to Build Confidence, Enhancing the patient experience and outcomes, Asking the patient to list their concerns, Planning the visit by prioritizing immediate issues and saving the other concerns for a follow-up appointment, Concluding visit and discussing follow-up. https://www.ahrq.gov/ncepcr/tools/improve/index.html, AHRQ Publishing and Communications Guidelines, Evidence-based Practice Center (EPC) Reports, Healthcare Cost and Utilization Project (HCUP), AHRQ Quality Indicator Tools for Data Analytics, United States Health Information Knowledgebase (USHIK), AHRQ Informed Consent & Authorization Toolkit for Minimal Risk Research, Grant Application, Review & Award Process, Study Sections for Scientific Peer Review, Getting Recognition for Your AHRQ-Funded Study, AHRQ Research Summit on Diagnostic Safety, AHRQ Research Summit on Learning Health Systems, National Center for Excellence in Primary Care Research, Research and Training Funding Opportunities, Health Information Technology Integration, Oral, Linguistic, & Culturally Competent Services, Practice Transformation & Quality Improvement, Tools and Resources for Clinical Practice, AHRQ Health Literacy Universal Precautions Toolkit, Guide to Improving Patient Safety in Primary Care Settings by Engaging Patients and Families, Primary Care Practice-Based Research Networks, U.S. Department of Health & Human Services. Our outcomes related to IP competency are at present indirectly measured through mentor assessment and project achievement (successful projects are likely associated with effective teamwork). All residents are encouraged to submit their projects or clinical vignettes to regional and national academic meetings. The 2022 program focuses specifically on quality of service, clinical quality, member satisfaction and safety, pharmacy, and diversity and inclusion. In 2015, we increased the number of meetings from once to twice a month based on trainee and mentor feedback. We calculated descriptive statistics for each item and used paired samples t tests to compare pre/post self-assessment ratings for all trainees who completed both assessments. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol), Primary Care Practice Facilitation CurriculumModule 22: Running Effective Meetings and Creating Capacity for Practices to Run Effective Meetings, Context for Successful Quality Improvement, The influence of context on quality improvement success in health care: a systematic review of the literature, A new typology for understanding context: qualitative exploration of the Model for Understanding Success in Quality (MUSIQ). the purpose of the quality improvement (qi) pilot project described here was to increase patient satisfaction by minimizing wait times in a florida county health department (chd) adult primary care unit (apcu) practice using the dartmouth microsystem improvement curriculum (dmic) framework (nelson, batalden, & godfrey, 2007) and the Additionally, using a data-driven approach can help engage stakeholders and make a compelling case for change. Large conference room for all-team meetings. Using an improvement platform like Life QI, which supports the PDSA approach, can really help you plan and measure your new . Aims: To report on an effort to assist small primary care practices in improving quality of care and efficiency of practice management to meet the needs of patients . The implementation of the "Amnesty Boxes" as a Quality Improvement initiative is another simple idea that saves the hospital thousands in supplies costs while making the end-of-shift transition easier for staff. Selecting a Project Theme: a 1-hour group discussion to determine project theme by completing an effort/yield analysis and drafting SMART aims for potential ideas. We invested effort in faculty development for QI mentors, using multiple strategies to support effective mentorship and retention of experienced mentors. A cohesive model of health care includes quality-related goals, tools, and techniques that are necessary in order for health care professionals to achieve quality improvement goals. Experts interviewed for this article cited two nursing-related quality improvement projects they were involved with that were simple, but very beneficial. Common QI tools QI tools are standalone frameworks that can be used as part of the approaches described above. A majority of the patients treated reside in the local area, with many viewing the clinic and staff as their primary care. 5600 Fishers Lane Trainees worked in mentored IP teams to select, design, implement, evaluate, and present a project as part of a 9-month curriculum. Engaging learners through modules in quality improvement and patient safety, An integrated, multimodal resident curriculum in patient safety and quality improvement, Quality improvement education in residency training: a review, Quality and safety education: foreground and background. You may notice problems with Our program has developed a comprehensive quality improvement and patient safety curriculum for our trainees in order to prepare them for the changing landscape of health care. To help with this, there are growing numbers of evidence-based Quality Improvement (QI) methods that can help practitioners to assess and improve the care they provide. A primary care practice will not reach its full potential without adequately addressing patients' mental health needs. Achieving 100% Documentation of the Pre-operative Checklist Beta Blocker Section. 1 Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Director for Clinical Care and Education, Center of Excellence in Primary Care Education, San Francisco VA Health Care System, 2 Professor Emerita, University of California, San Francisco, School of Nursing; Faculty Consultant, Center of Excellence in Primary Care Education, San Francisco VA Health Care System, 3 Assistant Clinical Professor, University of California, San Francisco, School of Nursing; Associate NP Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System, 4 Assistant Clinical Professor, University of California, San Francisco, School of Nursing; Co-Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System, 5 Assistant Professor, University of California, San Francisco, School of Pharmacy; Associate Director of Pharmacy, Center of Excellence in Primary Care Education, San Francisco VA Health Care System, 6 Adjunct Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Director of Scholarship and Evaluation, Center of Excellence in Primary Care Education, San Francisco VA Health Care System, 7 Professor, Department of Medicine, University of California, San Francisco, School of Medicine; Associate Chief of Staff for Education, San Francisco VA Health Care System; Co-Director, Center of Excellence in Primary Care Education, San Francisco VA Health Care System, Promoting Quality Improvement in Primary Care Through a Longitudinal, Project-Based, Interprofessional Curriculum, Logic Model for Interprofessional QI Curriculum.docx, Trainee Evaluation of QI Introductory Sessions.docx, GUID:8FA23DEC-00EA-452A-8419-EC7A87EE2714. This ongoing project focuses on developing approaches to improve patient safety in primary care settings through the engagement of patients and families. If you already have a great workflow in your clinic, check out this list of other performance improvement projects. Partnering junior faculty with senior faculty also built a more proficient group of mentors over time. If the pilot project is successful, there is potential for implementation of the QI project agency wide. Given these conditions, we could not report long-term outcome data and have relied on sustatined processes, products, and observable behavioral change as reported by clinical medical directors as evidence of long-term impact. Leading factors for successful implementation included attention to team-building and faculty development. Key attributes include attention to building high-functioning QI teams, completion of scholarly projects, and regular inclusion of stakeholder feedback and assessment to guide curriculum adaptations. We evaluated the achievement of educational objectives via trainees' self-assessments (Appendix H), appraisal of team posters, and mentor perceptions of teams' performance (Appendix I). Department. Meeting the challenge of practice quality improvement: a study of seven family medicine residency training practices. J Community Health . Self-Management Support Self-management support is an important part of patient-centered care and care coordination in primary care settings. With the exception of the first two sessions, the introductory sessions were separated by QI team and included time to apply QI methodology towards the trainees' selected project. The purpose of this quality improvement project was to improve the accuracy of patient contact information in order to increase the follow-up contact rate after being seen in the urgent care clinic. VI.A.1.b) Quality Improvement. At times, outcome data were collected in a labor-intensive manner that could not be sustained. 2018;22:17179. 2022 Jun;47(3):400-407. doi: 10.1007/s10900-022-01068-6. Key attributes of our curriculum included being (1) authentic (provide opportunities to learn QI knowledge and skills with projects that address real workplace problems), (2) team based (trainees work in IP QI teams, often with clinic staff), (3) mentored (team mentors have expertise in QI and local clinic context), and (4) integrated (formal teaching of QI concepts and tools occurs alongside project work). https://doi.org/10.1136/bmjoq-2017-000221. QI Project Examples. Rugen KW, Watts SA, Janson SL, et al. All healthcare processes have certain tangible characteristics that make it possible to measure them, analyze them, control them, and most of all, improve them. The three aims of the QIPC program are: improving data quality; utilising practice data to improve patient care; and identifying potential business . Drs. Title: Surgical Team Networks as a Basis for Quality Improvement Contact: Jonathan Coleman Title: Lean Principles in the Anesthesiology Technician Workflow: Decreasing Waste to Improve Value Added Time Contact: Aditi Dasgupta Title: Improving the Quality and Impact of Interdisciplinary Rounds at Tulane Medical Center Contact: Beau Saccoccia Funds are available to assist with registration and travel expenses. Step 1: Diagnose - assess the area of your practice or organisation that requires improvement, and generate some baseline data. All teams were expected to document aim statements, PDSA cycles, process maps, and cause-and-effect (fishbone) diagrams in meeting minutes and/or posters, as well as to compose work-in-progress reports and posters. We calculated descriptive statistics (minimum, maximum, mean, standard deviation) for each item. Issue Brief #3: Health Care Quality, Health systems science curricula in undergraduate medical education: identifying and defining a potential curricular framework. Alternatively, a QI curriculum may be a key activity around which to build an IP teaching collaboration in a clinical setting that already hosts trainees of different professions. In this article, we describe our experience over the last 7 years transforming the care delivered in our large primary care practice. Blanchard RD, Pierce-Boggs K, Visintainer PF, Hinchey KT. Chase SM, Miller WL, Shaw E, Looney A, Crabtree BF. 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