Accelerating Performance Improvement in Primary Care: A Practice-based Interprofessional Curriculum

Saturday, April 25, 2015
Key Ballroom 11-12 (Hilton Baltimore)
JoAnne M. Saxe, RN, ANP-BC, MS, DNP, FAAN, Department of Community Health Systems, University of California San Francisco, School of Nursing, San Francisco, CA, Maya Dulay, MD, University of California San Francisco, Department of Medicine, San Francisco VA Medical Center, San Francisco, CA and Bridget O'Brien, PhD, Department of Medicine, University of California San Francisco, San Francisco, CA
Abstract:
Engaging health professional learners in performance improvement (PI) in complex care delivery systems can be challenging. Interprofessional training programs may be well-suited for teaching necessary skills for team-based improvement work.

In 2011, a VA center  and the faculty of a university implemented an interprofessional training program for nurse practitioner (NP) students, medicine (MD) residents and associated health trainees as one of five VA Centers of Excellence in Primary Care Education.1PI is a core educational objective.

Faculty delivered 5 PI didactic sessions about the Model for Improvement2 and related tools using examples from the clinic setting. After reviewing practice data and performance measures, trainees formed interprofessional teams and selected a project theme. Each session included time for teams to apply the learning material to their projects. Trainees also completed Institute for Healthcare Improvement Open School Courses.3  With clinical faculty mentors and input from staff, trainees conducted Plan-Do-Study-Act (PDSA) cycles throughout the year. PI team meetings focused on team processes and using structured PDSA templates. Teams presented their work at an annual Quality Symposium.

From 2011-2014, 27 NP students, 75 MD residents and 15 associated health trainees participated in the curriculum. Trainees completed a self-assessment survey of their comfort with PI skills; ratings improved significantly on all 12 items from pre- to post- curriculum. Fifteen of the 21 projects resulted in sustainable changes in the clinic.

This curriculum has influenced PI course development at the university. In 2015, the interprofessional continuous quality improvement curriculum, along with the patient safety curriculum, and a guide for clinical faculty and PI mentors will be accessible via MedPORTAL iCollaborative4.  

Effective project-based interprofessional PI curricula can foster the development of high-functioning teams, promote a clinic-wide culture of improvement and result in sustained improvement in care-delivery. Key essentials for driving and sustaining changes that are needed for improving care include: 1) cultivating a culture dedicated to PI by providing resources and support to staff and mentors, 2) providing real-time feedback and progress reports to learners and their teams, and 3) a detailed communication plan between faculty, trainees and stakeholders through all PI phases.

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