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Dr. Joshua Tepper

Learning the Science of QI

Quality Improvement (QI) is science, not magic, and should be taught with the frequency and rigour of any scientific discipline in healthcare. Teaching Quality Improvement is not a straightforward matter but must be done, and done right, if we want to see the healthcare system improve.

Dr. Roger Wong, associate dean of postgraduate medical education at the University of British Columbia and author of a 2015 book on teaching Quality Improvement to medical residents, wrote in the preface that “there is no single, established curriculum to teach QI in medical education, even though QI is a mandatory core competency that all physicians must learn ...” Scholarly articles written over the past few years note a similar lack of consistency in the training of nurses in QI activities.

However, the need to train health care providers properly in quality care is fundamentally important to helping change the culture in health care, as the recent Health Quality Ontario report: Quality Matters: Realizing Health for All points out.

Teaching Quality Improvement requires understanding the theoretical underpinning that makes such approaches effective.

This point was well made recently by a pair of Canadian physicians affiliated with Western Ontario in a letter to the editor in the journal BMJ Quality & Safety. Commenting on another article, Drs. Andrew Smaggus and Mark Goldszmidt noted “the failure within health care to develop a nuanced understanding of the theoretical basis for improvement methodologies.”

As a result, they added somewhat provocatively, “the pressure to pursue quality improvement initiatives may presently exceed our expertise for achieving them successfully…It may be that we are incentivising efforts that quickly create the impression of pursuing quality (for administrators, department heads, and regulatory bodies), without adequately attending to the more arduous efforts required for developing expertise regarding the concepts, mechanisms and essential elements that create meaningful improvement.”

Quality Matters: Realizing Health for All recommends not only that health care organizations target 50% of their staff to complete basic improvement science training, but that universities and colleges ensure clinical curricula include Quality Improvement as a competency taught to all students.

The report notes many examples where QI is already being taught effectively:

  • IDEAS (Improving and Driving Excellence Across Sectors), a province-wide initiative that offers two accredited Quality Improvement learning programs, online resources, and an active alumni program to build and sustain a vibrant Quality Improvement culture.
  • The EXTRA executive training program and improvement collaborative offered by The Canadian Foundation for Healthcare Improvement.
  • Forums to foster system-level capacity, such as our annual Health Quality Transformation annual conference and the Quality Improvement and Patient Safety Forum that we co-sponsor.

The success of such programs is demonstrated through projects such as those developed in the IDEAS Advanced Learning Program in which over the course of a 5-month program, participants identify an issue and develop, implement and report on a Quality Improvement project in their own organization or local health system. This program has resulted in the development of tangible Quality Improvement initiatives in the community such as improving access for people with mental health and addiction issues or designing a sustainable intake and electronic coordinated care plan processes. Since its initiation, 500 individuals have completed the program and have developed a total of 160 QI projects.

The Quality Matters report states that “…building capacity in quality improvement is an issue of both supply and demand; of not only making available more food for learning but also stimulating the appetite to continually improve.”

By adopting scientific principles in learning about Quality Improvement and applying them on an ongoing basis, all those interested in higher quality care in our health care system can help ensure this goal is met.

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