Hands-on quality improvement through interdisciplinary partnerships

Physician-nurse collaboration is critical to quality care. Attention is directed to patient-centered care, evidence-based practices, systems-based practices and demands for transparent outcome data, requiring professionals to possess the knowledge and skills to assess and improve quality. Moreover, the increasing complexity of healthcare accentuates the impact of interdisciplinary partnerships, which must be purposely nurtured in students and new practitioners. Although quality outcomes are linked to interdisciplinary efforts, little is reported about the educational or clinical outcomes of Quality Improvement (QI) programs or the processes that facilitate effective teamwork. This presentation describes an innovative training program that combines the science of QI with understandings about teamwork and relationship building. Drawing on lessons learned from evaluations of previous courses, we designed a curriculum to foster effective team interactions through QI projects among professionals and students. The hospital is used as a teaching/learning laboratory, providing real-time clinical issues and hands-on learning. The program, implemented with physicians and nurses in the acute-care facility, focuses on shared clinical micro-systems and actual clinical challenges. Small interdisciplinary teams are provided opportunities and resources to address clinically relevant issues. Both the didactic content and learning activities emphasize teamwork as an integral component of the QI process. Trainees collaboratively design and conduct QI projects, mentored by leaders in their clinical areas. The Institute of Healthcare Improvement's (IHI) domains of knowledge provide the framework with which trainees choose a QI focus, consider alternative practices, conduct projects and examine outcomes. The curriculum is modified for students to foster QI skills and professional relationships prior to professional practice. Activities focus on quality and safety in hospital settings. Student participants, upper-level medical and nursing students from affiliated schools, participate over a 6-month period. Sessions included small group discussions led by clinician preceptors and involvement in a unit-based QI project. On-line education modules, developed by the IHI Open School for Healthcare Professionals, provide accessible resources between sessions. We also describe strategies to assess the program's impact on patient and institutional outcomes and physician-nurse relationships. Clinician training is assessed as participants' satisfaction, attitudes and knowledge; clinical outcomes are examined according to the initiatives' impact on patient satisfaction, quality care, safety, and efficiency. Evaluation of the student program assesses changes in QI knowledge and satisfaction. Data shows increased QI knowledge and, perhaps more salient, participants' valuing of QI skills and of inter-professional relationships. We believe this program advances a model for QI training through collaboration.