Educating Professionals to Improve Health Care

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Educating Professionals to Improve Health Care
April 12, 2007 Leslie W. Hall, MD University of
Missouri - Columbia
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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

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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

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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

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Curriculum on Patient Safety Quality
RT students
MHA students
2006
Nursing students
Medical students
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Interprofessional Curriculum 2006
Week 1 Health Care Team
Week 2 Improving the Health Care System
Week 3 Patient Safety
Week 4 Root Cause Analysis
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Course Evaluation

• Attitudes and self-reported behaviors around
  patient safety and quality assessed
• Knowledge based exam
• Learner evaluations

Surveys completed
Preclinical
Clinical
Year 1 Year 2 Year 3
Year 4
Curriculum administered
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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 8194-101.
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1Very Uncomfortable, 3Neutral, 5Very
Comfortable
Madigosky W, et al. Academic Medicine 2006
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Adding a Safety Booster
Patient SafetyCurriculum
Patient SafetyBoosters
½ of class No booster ½ of class Booster
Year 1 Year 2
Year 3 Year 4
Preclinical
Clinical
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Comfort in analyzing a case to find the cause of
an error
p 0.03
1Very Uncomfortable, 3Neutral, 5Very
Comfortable
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Interprofessional Curriculum
2007
45 min intro lecture
6 Hours of small group work
Final presentation
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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

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Value of IP Experience
Percent of students who valued the
interprofessional nature of experience
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Perceived Benefit to Career
Percent of students who felt experience would
benefit future career
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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
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Summary of Lessons Learned (offered by students)

• Interdisciplinary cooperation does work!
• Value of different professional perspectives
• Blaming doesnt accomplish much
• Obvious problems arent always that Obvious
• There is a systematic way to change systems
• Dont bring a knife to a gunfight

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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

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Safety Competencies after IP Curriculum in
Safety/Quality - 2007
At the p lt 0.05 level
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Post-training Differences 2006 vs. 2007
Understanding of Other Professions
p lt 0.001
p NS
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
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Post-training Differences 2006 vs. 2007
Understanding of Other Professions
p lt 0.001
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
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Post-training Differences 2006 vs.
2007Teamwork Skill Development
p lt 0.001
p NS
of respondents from each discipline agreeing
with statement Interprofessional learning is an
effective strategy for teamwork skill
development
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Post-training Differences 2006 vs.
2007Teamwork Skill Development
p lt 0.001
of respondents from each discipline agreeing
with statement Interprofessional learning is an
effective strategy for teamwork skill
development
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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.

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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

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ACT 2007

• Interprofessional model for experiential learning
  of quality improvement

The Internal Med Team
One MSN student
One pharmacist
Two inpatient nurses
Four integrated residents
Two attending physicians
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ACT Timeline
1st Learning Session
2nd Learning Session
3rd Learning Session
Project Presentations
October November December January
February March
2006 2007
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ACT Timeline
1st Learning Session
2nd Learning Session
3rd Learning Session
Project Presentations
Ongoing Project Work and Experiential Learning
October November December January
February March
2006 2007
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Learner Feedback
Mean score of respondents to statement that the
ACT experience helped them to develop greater
teamwork skills or QI Skills 1 Strongly
disagree to 5 Strongly agree
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Learner Feedback
Mean score of respondents to statement that the
ACT experience helped them 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
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Tracking Outcomes - ACT

• Outcomes being analyzed
• Educational Learner evaluations
• Attitudes regarding other professions
• Knowledge assessment (QIKAT)
• Clinical outcomes of projects

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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

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History of CRM Training at MU

• First class May, 2003
• Since then, appx 1200 trained
• Feedback very positive

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Bringing CRM Concepts to Life at UMHC

• Med-Neuro ICU AM Pre-briefs
• Time Out Check-list for OR

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Safety Tool Implementation

• Standardized nurse-to-nurse reports in ICUs
• Pre-catheterization checklists
• Post-cath handoffs from cath lab to floor

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Safety Tool Implementation

• One minute nurse-physician phone huddle for
  Family Medicine admits

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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

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Faculty Development

• Faculty champions needed at all levels of
  curriculum to succeed
• Multiple concurrent efforts to advance faculty
  skills in quality/safety
• Revamping of MM Conferences
• Quality Safety Fellowships
• Quality Leadership Development Course planned for
  Fall, 2007
• IHI Health Professions Collaborative

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IHI Health Professions Education 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.

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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

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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

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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