Building Skills in Organizational and Systems Change: A DNP Curricular Thread

Skills in leading organizational and systems change within healthcare settings are essential for the DNP prepared nurse practitioner (NP) and consistent with the Institute for Healthcare Improvement (IHI) Triple Aim of improving the quality of care, the health of populations and reducing cost. Graduates must be proficient in quality improvement (QI) strategies, creating and sustaining change at the organizational level. Expertise in assessing and identifying systems issues and facilitating change in practice delivery are critical for patient-centered care that is safe and effective, and leads to improved patient and healthcare outcomes. The DNP graduate has a pivotal role in these QI efforts and needs the skill set and knowledge to assess, implement and evaluate effective changes in practice delivery.

A curricular thread in the DNP FNP program helps students build skills in organizational and systems change. Students learn leadership skills in Lean management principles and quality improvement strategies to create and deliver quality care with reduced cost. In the clinical series, they start by identifying issues in mobilizing resources, coordinating care and advocating for equity at the systems level, moving on to recognizing clinical systems level changes needed to insure higher quality care. A leadership case is introduced in the second year which requires teamwork to integrate process improvement skills in an evaluation of chronic disease management delivery in the outpatient setting. Early in the third year, students incorporate panel management into care delivery, focusing on interprofessional collaboration to improve quality of care and decrease cost (Triple Aim). In the final clinical rotation, they implement an assessment of a practice change, working with the clinical team to evaluate the current process and plan for improvement.

Evaluation is competency based and reflects ongoing skill development. Methods include meeting quarterly clinical competencies, presenting leadership case plans to fellow students for feedback and discussion, presenting clinic process improvement assessments and implementation plans to peers and  agency personnel and completing a self-reflection  on their role in the process.

Supported by funds from the Department of Health and Human Services Health Resources and Services Administration  D09HP07344