OBJECTIVES

In 2003, the University of Missouri-Columbia School of Medicine (MU SOM) initiated an integrated quality improvement-interprofessional collaborative practice (QI-ICP) curriculum as part of a larger curriculum renewal process. While exploring a different case study focused on the content of the curriculum, investigators became intrigued by MU SOM's approach to change, specifically, how complex adaptive systems (CAS) thinking may have supported sustained transformational change in curriculum across multiple health professions programs. The primary aim of this study was to elucidate the aspects of MU's experience with transformation that were grounded in CAS. A secondary aim was to explore the usefulness of a CAS-based management framework for organizational transformation using the case of curricular transformation in health professions education at MU.

METHODS

Data collection involved interviews, with twelve faculty from a variety of programs, and document analysis, including previously published papers and gray literature (websites, organizational charts and planning documents, and faculty development materials).

RESULTS

Using abductive analysis, we found that leadership in the health professions programs at MU, informed by earlier learning about organizational sensemaking and CAS theory, addressed all 9 of the characteristics of CAS presented in the initial framework. Additionally, systematic combining revealed the need to adjust the framework to ensure applicability to health professions education. The analysis of MU's experience also offered key insights into how that transformation happened in practice. The CAS framework adjustments make explicit the importance of common purpose and the concept of leadership as an emergent event and make it easier to apply the framework to a broader set of organizational contexts, including health professions education.

CONCLUSION

The use of the adjusted framework, informed by insights from this specific case, may help health professions education programs evaluate past change efforts or plan for future change.

Objectives: Despite decades of effort, programs continue to struggle to integrate competencies related quality improvement (QI) and interprofessional collaborative practice (ICP) into health professions education. Additionally, while QI and ICP may seem intuitively linked and there exists some examples of a coordinated approach, the literature regarding competencies, including knowledge, skills, and attitudes (KSAs), is still largely focused on QI and ICP as separate fields of knowledge and practice. This study explored distinctions and connections between quality improvement (QI) and interprofessional collaborative practice (ICP) competency domains in health professions education.

Methods: The authors used a qualitative case study approach with an instrumental case, that is, the University of Missouri-Columbia (MU), where QI and ICP were intentionally integrated as part of core curricula in health professional schools and programs. Eleven faculty members from medicine, nursing, pharmacy, and health care administration participated in interviews exploring their teaching choices in either classroom or clinical settings.

Results: Study participants defined the goal of teaching QI and ICP as enabling learners to deliver safe and patient-centered care and described the knowledge and skills required for QI and the attitudes and skills required for ICP. Furthermore, they described the relationship between QI and ICP as one mediated by systems thinking, where ICP is backgrounded as a critical pre-requisite and QI is foregrounded as a vector for developing interprofessional competencies.

Conclusions: The MU case elucidates the potential synergies that occur when faculty address quality improvement and interprofessional collaborative practice competencies with an integrated approach that leverages connections, while also respecting distinctions. For health professions education programs looking to improve the effectiveness and efficiency of their curricular approach to these fields, it may be fruitful to consider ICP as background and QI as foreground, remembering that without each other, ICP risks losing meaning and QI risks losing impact.

This thesis investigated the intersection of quality improvement (QI) and interprofessional collaborative practice (ICP) in the context of health professions education. The overall aim of the thesis was to explore the potential synergies between QI education and ICP education and to develop a framework that supports a system’s approach to QI and ICP integration for health professional learners’ education.

Using a convergent parallel mixed methods approach, where the results of all the individual studies are synthesized in interpretation, the thesis is made up of one quantitative intervention study and three qualitative case studies. The intervention study analysed changes to self-reflection about interprofessional teams before and after participating in a QI activity. The qualitative studies used a mix of one-on-one interviews, stimulated recall interviews, document analysis, and a focus group.

The first study found significant increases in reflection scores in a majority of the 16 items measured, indicating that a quality improvement-focused learning activity in an ICP setting can support development of ICP related knowledge, attitudes, and beliefs. The second and third study reported on faculty perspectives about what should be taught in an integrated QI-ICP curriculum, in the form of competency domains, and how it should be taught in terms of curriculum design. The fourth study offered key insights into how program transformation in higher education can be better enabled in practice, using the integration of a QI-ICP curriculum as the case, while also suggesting refinements to a complex adaptive systems-based change management framework.

The findings of the four studies were synthesized through the lens of micro-meso-macro system perspectives and points of convergence and divergence were noted in order to develop a more complete picture of QI-ICP integration in health professions education. The results include a framework of design principles to support faculty to integrate QI and ICP education, whether working on curricular innovations in their own classroom, working on an interconnected program of learning, or attempting curricular transformation at the scale of the macrosystem.

INTRODUCTION: Blended learning has taken on new prominence in the fields of higher and continuing education, especially as programs have shifted in response to teaching in a global pandemic. The faculty at the Jönköping Academy's Masters in Quality Improvement and Leadership program has been offering a blended learning curriculum, based on four core design principles, since 2009. We studied key features of the enacted curriculum to understand conditions that can support an effective blended learning model. METHODS: We used a case study approach underpinned by interactive research. Document analysis, a focus group, individual interviews, and stimulated recall interviews were used for data collection. Themes were identified through qualitative content analysis and data reduction, data display, and conclusion drawing. RESULTS: We grouped data into six emergent themes that clarify the enacted curriculum of an established Master's program: focusing on a common purpose, developing technical and relational knowledge and skills, linking theory and practice in the workplace, leveraging collaboration for mutual benefit, concentrating on leadership and coaching, and applying a blended and interprofessional learning model. CONCLUSION: Educators faced with increased demands to be flexible and to offer opportunities for distance education can learn from this case example of effective teaching of quality improvement and leadership in a blended format.

Problem

Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting.

Approach

From 2008-2012, an iterative, interactive process was used to develop the ECLS model and its core elements-patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012-2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site's ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden).

Outcomes

Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites.

Next Steps

The next test of the model should be prospective, linked to clinical and educa tional outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development. 

The Saskatchewan Ministry of Health has committed to a multi-million dollar investment toward the implementation of Lean methodology across the province's healthcare system. Originating as a production line discipline (the Toyota Production System), Lean has evolved to encompass process improvements including inventory management, waste reduction and quality improvement techniques. With an initial focus on leadership, strategic alignment, training and the creation of a supportive infrastructure (Lean promotion offices), the goal in Saskatchewan is a whole health system transformation that produces "better health, better value, better care, and better teams." Given the scope and scale of the initiative and the commitment of resources, it is vital that a comprehensive, longitudinal evaluation plan be implemented to support ongoing decision-making and program design. The nature of the initiative also offers a unique opportunity to contribute to health quality improvement science by advancing our understanding of the implementation and evaluation of complex, large-scale healthcare interventions. The purpose of this article is to summarize the background to Lean in Saskatchewan and the proposed evaluation methods.

This article examines educational settings, intersections and participation in a master programme in healthcare given as blended learning. Regarding communication between learners and teachers dialogical intersections were found between campus and home as well as between campus and work. Furthermore, not only learners but also teachers worked from other physical locations than campus. In communication between learners, dialogical intersections were found between home and campus, work and campus, and between home settings. Discussion and assignment tools were used in other settings than campus and were found to enhance learning and reflection by learners. Communication patterns in synchronous and asynchronous online seminars were characterised by a high share of communication between learners. However, the share of teachers’ postings increased in online seminars devoted to support on course content from expert teachers. The article is concluded with implications of the findings for planning and structuring of blended learning.