Laying the Groundwork to Foster Leadership in Continuous Quality Improvement

As we continue our series on innovation through electives in pharmacy education, we will discuss a new course on continuous quality improvement (CQI) at the MN-COP.

Teaching CQI

Launching in January 2017, Continuous Quality Improvement to Optimize Medication Use is the first MN-COP course to focus squarely on CQI education and experience. As healthcare shifts from fee-for-service to pay-for-performance models, quality of care is becoming ever more important. Pharmacists are expected to demonstrate their value to the team and the quality care they provide for the organization. By learning CQI models in pharmacy education, students may be more prepared to build the skills, confidence, and mindset to step into leadership roles as practitioners.

 

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Dr. Sorge

The course instructors bring salient experiences in CQI and leadership. Course director and instructor, Lindsay Sorge, PharmD, MPH, BCACP provides a perspective of balancing clinical practice and population management.  She has been actively involved in both small primary care CQI projects, as well a large national grant aimed at improvement in comprehensive medication management (CMM) in primary care. 

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Dr. Kerwin

 

Lara Kerwin, PharmD, second-year Pharmaceutical Care Leadership Resident led a CQI project at her first-year residency practice site (a family medicine clinic).  She realized that although it provided her a great learning experience, she could have been even more effective in providing fidelity to the CQI models she employed in the process.

Dr. Kerwin reflects on her desire to teach CQI: 

“In the true spirit of quality improvement, it is important to look upstream. If we can expose students to this work before they graduate, we can begin to develop their competence in these areas that they can build upon as practitioners.”

Focusing on Team, Leadership & CQI

In designing the course, a thorough literature evaluation was performed to assess the existing work in healthcare education. Literature in medicine, nursing, dentistry, and public health were reviewed. The course instructors also discussed education in CQI with their colleagues at the University of Minnesota Medical School.

Team, leadership, and CQI were identified as the central themes, based on the course instructors’ experience and a framework described in McLaughlin and Kaluzny’s Continuous Quality Improvement in Health Care.1

Throughout the course, students receive instruction in a variety of CQI models. Although the models may bring similar approaches to quality improvement, it is important that they are familiar with the varying terminology in order to develop a CQI mindset that allows them to engage in a CQI team with whichever model their organization has adopted. The Model for Improvement, adopted by the Institute for Healthcare Improvement (IHI),2 has formed the basis for the students’ personal CQI project, and has been beneficial in emphasizing a complete CQI process from beginning to end. Six Sigma and Lean models have also been presented. When the students are given repeated exposures to the models, they are able to reinforce learnings, recognize successes in their own projects, and then begin to apply the principles to future experiences.

Dr. Kerwin articulated:

“We needed opportunities in the course for practical experience and failing forward to create opportunities for growth in knowledge, reflective ability, and skill sets. We often have the students submit something first to offer them formative feedback prior to formal, summative assessment. This creates a lower-stakes opportunity to build comfort with these new skills and put the skills into practice.”

CQI Leaders Provide Insights and Expertise

Guest speakers have been integrated into the class time in order to provide more depth to the students’ instruction in CQI. The list below outlines individuals and the topics they presented to the class during the Spring 2017 class offering:

  • Kim McCoy, MPH, MS, Stratis Health — “Quality Improvement Organizations”
  • Megan Hicks, MHA, Minnesota Department of Health — “QI Models Overview”
  • Brandon Ordway, PharmD, MS, St. Joseph’s Hospital, HealthEast — “Creating a Local Measurement Plan”
  • Chrystian Pereira, PharmD, Smiley’s Family Medicine Clinic — “Team Building”
  • Dan Rehrauer, PharmD, Health Partners — “Introduction to Population Health”
  • Caryn Ward, PhD, National Implementation Research Network — “Implementation Science”

The guest speakers have also brought an interesting perspective to the course – the students have appreciated the opportunities to connect with practitioners and this has even resulted in mentorship and partnership between students and practitioners outside of the classroom. Although this was not a formal objective of the course, students have articulated that these relationships have been a great benefit!

An Opportunity to Experience CQI

At this point in the semester, all students have a personal CQI project identified and all students have written their aim statements. They have decided their baseline measurement strategy and some have started running interventions. Projects range from clinical practice improvements to personal health goals. Students were given the opportunity to frame their project to best fit a personal interest or area of their life where they sought improvement. They seem to view this as a benefit of the course – to actually make a change in their lives while learning a CQI process.

Understanding the Effect

Evaluation of the course will be essential for moving forward and assessing how well the students are achieving the objectives. In addition to traditional forms of assessing learning and determining student satisfaction, the course instructors are completing“field notes” following each class session.  They each respond to the following questions: 1) What surprised me? 2) What intrigued me? 3) What disturbed me?3  This method of evaluation recognizes the importance of an instructor’s daily observations of student learning and allows examination of the progression of the course over time.  

The first offering of Continuous Quality Improvement to Optimize Medication Use has given pharmacy students an opportunity to explore team, leadership, and CQI. The students have benefitted from the opportunities to be submersed in CQI models, while connecting with practitioners and conducting their own individual CQI projects. We look forward to subsequent course offerings!

References:

  1. Johnson JK, Sollecito WA. A Call to Action for Transforming Health Care in the Future. In: Sollecito WA, Johnson JK, eds. McLaughlin and Kaluzny’s Continuous Quality Improvement in Health Care. 4th ed. Burlington, MA: Jones & Bartlett Learning; 2011.
  2. The Model for Improvement was developed by Associates in Process Improvement. [Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.
  3. Stone Sunstein B, Chiseri-Strater E. Fieldworking: Reading and Writing Research. 4th ed. Boston, Massachusetts: Bedford/St. Martin’s; 2012.

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