A Comprehensive Model to Build Improvement Capability in a Pediatric Academic Medical Center

doi:10.1016/j.acap.2013.02.007

Academic Pediatrics

Volume 14, Issue 1, January–February 2014, Pages 29-39

https://doi.org/10.1016/j.acap.2013.02.007 Get rights and content

Abstract

Cincinnati Children’s Hospital Medical Center developed a comprehensive model to build quality improvement (QI) capability to support its goal to transform its delivery system through a series of training courses. Two online modules orient staff to basic concepts and terminology and prepare them to participate more effectively in QI teams. The basic program (Rapid Cycle Improvement Collaborative, RCIC) is focused on developing the capability to use basic QI tools and complete a narrow-scoped project in approximately 120 days. The Intermediate Improvement Science Series (I²S²) program is a leadership course focusing on improvement skills and developing a broader and deeper understanding of QI in the context of the organization and external environment. The Advanced Improvement Methods (AIM) course and Quality Scholars Program stimulate the use of more sophisticated methods and prepare Cincinnati Children’s Hospital Medical Center (CCHMC) and external faculty to undertake QI research. The Advanced Improvement Leadership Systems (AILS) sessions enable interprofessional care delivery system leadership teams to effectively lead a system of care, manage a portfolio of projects, and to deliver on CCHMC’s strategic plan. Implementing these programs has shown us that 1) a multilevel curricular approach to building improvement capability is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing capable interprofessional improvement leaders, versus engaging in broad general QI training across the whole organization, is effective.

Section snippets

Guiding Principles

We developed a conceptual framework for a comprehensive model for improvement science education that would both meet our needs and be practical. Our experience convinced us that applying sound adult education principles was a necessity. David Kolb’s theory of experiential learning18, 19 forms the basis for many adult education efforts and became the pedagogical foundation for our development of a more comprehensive system of building improvement capability. On the basis of our experiences, and

Implementation Example

Our training programs have reached a broad audience at CCHMC. Table 4 shows the distribution of participants in our training programs across staff categories. Faculty from 19 of 26 medical divisions within the Department of Pediatrics, 9 of 11 divisions within the Department of Surgery, and the Anesthesiology and Radiology Departments have participated in one or more of the training programs.

One CCHMC pediatric division serves to illustrate the use of our model. Emergency Services was an early

Discussion

We have observed 4 key learnings from our work: 1) a multilevel curricular approach is pragmatic and effective, 2) an interprofessional learning environment is critical to shifting mental models, 3) repetition of project experience with coaching and feedback solidifies critical skills, knowledge and behaviors, and 4) focusing first on developing a critical mass of capable interprofessional improvement leaders across the organization, versus engaging in broad general QI training for the whole

Acknowledgments

Supported in part by a grant from the Robert Wood Johnson Foundation, Evaluating Quality Improvement Training Programs 65499.

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Replicating one institution’s successful QI program at other institutions is challenging since the success of QI depends on managing numerous local contextual factors, such as leadership style, resource allocation, logistical coordination, and organizational culture [5]. Furthermore, the most successful QI training programs are highly experiential, incorporating coaching, leader support, and frequent reporting on progress [6]. In March 2020, an in-person QI training program developed at one institution was replicated and launched at two other institutions.
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We found the structured problem-solving method, along with timely focused QI education materials via a virtual platform, to be effective in simultaneously facilitating improvement projects from multiple institutions. The combination of two institutions fostered encouragement and shared learning across institutions.
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High-functioning quality improvement teams share a common purpose and goal and use effective communication practices. All team members participate in the work, and all feel comfortable speaking up regardless of rank or role [21,22,27]. The team should include a team leader, a clinical leader or individual with technical expertise, who will be the driver of the project and a project sponsor, someone with an executive authority who will review the progress regularly [28].
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Quality Improvement in EducationA Comprehensive Model to Build Improvement Capability in a Pediatric Academic Medical Center

Abstract

Section snippets

Guiding Principles

Implementation Example

Discussion

Acknowledgments

Jt Comm J Qual Saf

Jt Comm J Qual Saf

Jt Comm J Qual Patient Saf

Jt Comm J Qual Patient Saf

Pediatr Clin North Am

To Err Is Human: Building a Safer Health System

Crossing the Quality Chasm—A New Health System for the 21st Century

Preventing Medication Errors

The end of the beginning: patient safety five years after To Err Is Human

Health Aff (Millwood)

The long road to patient safety: a status report on patient safety systems

JAMA

Patient safety at ten: unmistakable progress, troubling gaps

Health Aff (Millwood)

Preparing the workforce

CQI progress reports: the dashboard approach provides a better way to keep board informed about quality

Healthc Exec

The Fifth Discipline: The Art and Practice of the Learning Organization

Knowledge for Action: A Guide to Overcoming Barriers to Organizational Change

Course research: using the case method to build and teach management theory

Acad Manage Learn Educ

The New Economics for Industry, Government, Education

Experiential Learning

Toward an applied theory of experiential learning

Control charts 101: a guide to health care applications

Qual Manag Health Care

Quality Improvement in Education
A Comprehensive Model to Build Improvement Capability in a Pediatric Academic Medical Center