The effectiveness of a unique two-pronged educational program has shown significant improvements in knowledge of quality principles by leaders as well as the successful design and launch of QI (quality improvement) projects by frontline staff, according to results outlined in an article in the April 2011 issue of The Joint Commission Journal on Quality and Patient Safety.
Lessons learned from the program results, which originated at Emory Healthcare in Atlanta, should be useful to health care organizations as they weigh alternative strategies to promote QI activities and a culture of quality across their organizations, according to authors led by Dr. Kimberly Rask, MD, Ph.D, an associate professor in the Rollins School of Public Health at Emory University. The projects that were implemented as part of the practical methods course are being systematically evaluated for sustainability and longer-term impact on patient outcomes.
"This initiative shows the feasibility of implementing a broad-based in-house QI training program for multidisciplinary staff across an integrated health system. Initial assessment shows knowledge improvements and successful QI project implementations, with many projects active up to one year following the courses," says Dr. Rask.
"The opportunity to improve quality and patient safety in health care settings has been well documented," Rask adds. "Health care organizations use a variety of strategies to promote quality improvement activities, but there is little evidence to date about the most effective strategies. Studies have shown that clinically focused training in QI techniques can improve patient safety and reduce inefficiency."
The project spanned five Emory hospitals and a multispecialty physician practice. One two-day program, 'Leadership for Healthcare Improvement,' was offered to leadership, and a four-month program, 'Practical Methods for Healthcare Improvement,' was offered to frontline staff and middle managers.
Participants in the leadership program completed self-assessments of QI competencies and pre- and post-course QI knowledge tests. Semi-structured interviews with selected participants in the practical methods program were performed to assess QI project sustainability and short-term outcomes. More than 600 employees completed one of the training programs in 2008 and 2009. Leadership course participants significantly improved knowledge in all content areas, and self-assessments revealed high comfort levels with QI principles following the training. All practical methods participants were able to initiate and implement QI projects.
Participants described significant challenges with team functionality, but a majority of the QI projects made progress toward achieving their aim statement goals. A review of completed projects shows that a significant number were sustained up to one year after program completion. Quality leaders continue to modify the program based on learner feedback and institutional goals.
Other researchers at Emory included: Richard S. Gitomer, M.D., chief quality officer, Emory University Hospital Midtown; Nathan O. Spell III, M.D., chief quality officer, Emory University Hospital; Steven D. Culler, Ph.D., associate professor, Rollins School of Public Health, Emory University; Sarah C. Blake, M.S., senior associate; Susan S. Kohler, R.N., M.P.H., senior research project associate; Jonathan N. Hawley, senior research project coordinator; and William A. Bornstein, M.D., Ph.D., chief quality officer, Emory Healthcare.
The project evaluation was supported by a grant from the Robert Wood Johnson Foundation's "Evidence for Improvement: Evaluating Quality Improvement Training Programs" initiative.
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