Training in quality and safety: the current landscape.

544194

research-article2014

AJMXXX10.1177/1062860614544194American Journal of Medical Quality XX(X)Karasick and Nash

Article

Training in Quality and Safety: The Current Landscape

American Journal of Medical Quality 1–13 © The Author(s) 2014 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/1062860614544194 ajmq.sagepub.com

Andrew S. Karasick, BA1 and David B. Nash, MD, MBA2

Abstract The current US health care environment requires and encourages the development and implementation of training programs focusing on quality improvement and patient safety. This article offers a new resource that details the basic characteristics of such physician-inclusive training programs. Specifically, program type, objectives, eligibility, cost, training length, and modality are aggregated and displayed to provide health care professionals with a new tool to facilitate individual education in the field of quality improvement and patient safety. Keywords health care, training, quality, safety In an era of health care that boasts advanced technology and innovative therapy, the United States still grapples with the uncomfortable truth that unnecessary medical harm still befalls far too many of the nation’s most vulnerable. Yearly premature deaths associated with hospital care–related preventable adverse events are well into 6 figures.1 In particular, the importance of quality improvement (QI) and patient safety (PS) training has been emphasized by the Affordable Care Act; specifically, the law provides for funding of “demonstration projects to develop and implement academic curricula that integrates quality improvement and patient safety in the clinical education of health professionals.”2 Many medical organizations also espouse the importance of PS and QI education. The American Board of Medical Specialties lists practice-based learning and improvement and systems-based practice as core competencies,3 both of which can be approached with QI/PS training. The Accreditation Council for Graduate Medical Education has established a program called Clinical Learning Environment Review, which emphasizes PS education and opportunities to demonstrate leadership in PS and QI.4 The Association of American Medical Colleges has developed a Teaching for Quality initiative that strives to have all clinically active faculty practicing and teaching PS and QI on a regular basis.5 This seemingly daunting task of educating an entire profession need not be solely the responsibility of health care employers. Individuals aware of the value of training and interested in pursuing training have many options available to them; however, these options are dispersed and may not be sufficiently visible to prospective eyes. Aggregation and categorization of an extensive group of

health care QI and PS training programs was performed to solve this problem. US-based academic programs explicitly designated as offering training for health care–centered QI and/or PS were reviewed. Programs were identified by means of a targeted search through an independent public search engine (Google). Specific keywords, including “master’s program patient safety,” “master’s program quality improvement,” “certificate program patient safety,” “certificate program quality improvement,” “PhD program patient safety,” “PhD program quality improvement,” “fellowship program patient safety,” and “fellowship program quality improvement,” were entered into the search engine. Sites obtained through 30 pages of search output per term were examined for distinguishing characteristics. Only US-based Web sites with health care–centered programs offering multispecialty physician inclusivity and a curriculum were included for compilation. Programs requiring preexisting in-house employment were excluded from the data. This compilation divides institutions into 3 tables: Table 1 summarizes organizations offering at least an independent master’s degree in a relevant field (ie, focusing on health care–related QI and/or PS), Table 2 summarizes organizations offering a fellowship or PhD in the aforementioned relevant field, and Table 3 summarizes organizations offering other programs in the aforementioned 1

Widener University, Chester, PA Jefferson School of Population Health, Philadelphia, PA

2

Corresponding Author: Andrew S. Karasick, BA, 1410 Colton Road, Gladwyne, PA 19035. Email: [email protected]

Downloaded from ajm.sagepub.com at FRESNO PACIFIC UNIV on December 26, 2014

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Master of Health Care Delivery Science

Master’s Programs

Master of Patient Safety

Massachusetts College of Pharmacy and Health Sciences; https://online. mcphs.edu/programs/ patient-safety-mps

Eligibility

Provide patient-centered care within an interdisciplinary team Emphasize evidence-based practice, QI, and informatics Focus on communication, medical error science, organizational change, and leadership to reduce risk and improve PS

(1) Develop, implement, and evaluate quality and patient safety improvement initiatives Cultivate strategies to lead organizational change toward a quality-focused culture Translate national quality expectations into daily operations Apply processes and tools to measure, analyze, and interpret quality improvement data Design and implement information technology systems to support quality assurance Conduct research to drive clinical and operational decision making (2) Same as above

(1) 10 courses (2 years)

(2) 5 courses (1 year)

(1) Est. cost $53 520

(2) Est. cost $26 760

(1) Undergraduate degree and 3+ years of work experience in health care

(2) Undergraduate degree and 3+ years of work experience in health care

34 credit hours

(2) 18 credits

(1) 36 credits

(1) Est. cost $29 520

(2) Est. cost $14 760

15 courses (18 months)

Training Length

$96 759

Cost

Bachelor’s degree with 2.8+ GPA Est. cost $28 900 and 2+ years work experience in health care

(2) Same as above

(1) Bachelor’s degree with 3.0+ GPA and relevant work experience in health care

5+ years of experience in health Solve problems and make decisions based on care delivery or a related field appropriate analysis of data, including clinical and financial data Understand health care systems at micro, meso, and macro levels, both actual systems of today and the potential systems that might be designed Be strategic communicators, capable team members, and skillful leaders Be capable of continually improving operations and quality care delivery Strategically and scientifically approach current and future health care delivery challenges

Objectives

(1) Master’s in Healthcare (1) Knowledge, skills, and methods in the following Northwestern University areas: care quality context and measurement, Quality and Patient Feinberg School of changing systems of care delivery and disparities, Safety Medicine-Center for accountability and public policy, safety Healthcare Studies; http:// interventions and practices, health information feinberg.northwestern.edu/ technology, simulation and the science of sites/chs teamwork, human factors and risk assessment methods, leadership and governance, learn about environment shaping health policy, particularly in regard to quality and safety (2) Obtain content and skills needed to (2) Certificate in be effective quality and safety practitioners and Healthcare Quality and leaders in health care Patient Safety

(2) Graduate Certificate in Health Care Quality

GW School of Medicine and (1) Master of Science in Health Science in Health Sciences; http:// smhs.gwu.edu/crl/programs/ Health Care Quality hcq

Dartmouth Institute for Health Policy and Clinical Practice; http://mhcds. dartmouth.edu/theprogram

Organizations

Modality

(continued)

(2) In-person instruction


Online instruction with onsite orientation

(2) Online instruction


In-person instruction (4 periods, 6 weeks total) and online (15 hours per week)

Table 1. Organizations Offering at Least an Independent Master’s Degree Focused on Health Care–Related Quality Improvement (QI) and/or Patient Safety (PS).


3

(2) Graduate Certificate in Healthcare Quality & Safety

(2) Graduate Certificate in Patient Safety, Error Science, and Full Disclosure

Abbreviation: GPA, grade point average.

(1) Master of Science University of Illinois at in Patient Safety Chicago College of Leadership Medicine; http://uic.edu/scs/ patient-safety/ms-structure. html

Objectives

Eligibility

Cost

Study historical approaches to safety and quality care and discover newer QI and risk-reduction strategies, such as information systems applications Learn about the Seven Pillars from the first implementer of this widely used, comprehensive process to respond to PS incidents (2) Develop organizational leadership skills specific to PS issues Learn strategies for proposing and implementing process improvements Learn advanced communication strategies for PS success in care systems

(1) Enhance organizational leadership skills specific to PS issues Learn to develop strategies for proposing and implementing process improvements Learn principles to improve communication in a care environment, conflict resolution techniques, and guidelines for team training

(2) Same as above

(1) College graduate with 2.75+ GPA and strong commitment to the field of PS and interest in improving the quality of health care

(1) Analyze US health care benefits and systems for (1) Bachelor’s degree with 3.0+ GPA delivering care services Design, conduct, and evaluate activities to measure 3+ years clinical experience or work in a clinical setting and improve care quality and PS Develop, analyze, and implement policies, care guidelines, and regulations relevant to care quality and safety Evaluate, select, and integrate information systems and technology that support decision making and workflow within and across health care settings Lead, manage, and develop policy approaches to address problems related to care quality and PS (2) Acquire the skills for design and implementation (2) Submission of scores from graduate level examination or a of programs and policies that measurably improve 3.3+ undergraduate GPA health care quality and PS

(1) 36 credit hours (20-22 months)

(1) Est. cost $27 720

(2) 12 credit hours (6-8 months)

(2) 18 credits (1-2 years)

(2) Est. cost $13 050

(2) Est. cost $9240

(1) 39 credits (2 years)

37 total credits minimum (up to 3 years)

Training Length

(1) Est. cost $32 604 to $40 794

Master of Health Science Provide a learner-centered educational experience Bachelor’s degree with 2.75+ GPA Est. cost $14 820 and 3+ years of prior health care that emphasizes critical thinking and decisionor health care administrative making abilities, while developing the capacity to management experience analyze published research Promote the concept of the scholar-practitioner and lifelong learning Encourage scholarly activity, such as publishing articles in peer-reviewed journals or speaking at professional conferences, for students and alumni Cultivate leadership qualities affording you the opportunity to become future leaders

Master’s Programs

Thomas Jefferson University- (1) Master of Science in Healthcare Quality & Jefferson School of Safety Population Health; http:// www.jefferson.edu/ population_health.html

Nova Southeastern University; http://nova. edu/chcs/healthsciences/ mhs/riskmanagement_ curriculum.html

Organizations

Table 1. (continued)


(1) Online instruction with 1-week on-site residency


(1) Online instruction, mentoring, on-site 7-day symposium to present capstone project

Online instruction, optional traditional classroom, internship/practicum

Modality

4


Quality Scholarship Program

American College of Medical Quality; http://acmq.org/

Physicians with 3+ years of clinical experience or nurse with master’s degree and 5+ years of clinical experience (including some QI or leadership experience)

Funded

US physicians who are Funded Understand the scientific basis of QI and PS, including in or have completed epidemiology and nature of medical error, quality a residency or measurement and data analysis, research and evaluation fellowship program design, improvement tools and techniques, and best practices Develop competence in designing and conducting QI projects using rigorous methods, the results of which can be communicated through publication Learn to facilitate/lead health care professions in multidisciplinary teams Understand and navigate the complex dynamics of hospitals/ clinical operations

Clinical Quality Learn history and fundamentals of QI Fellowship Program Learn quality measurement tools and techniques Learn to design safe systems and to build a “just” culture Learn skills and techniques for interdisciplinary teamwork and communication Learn how to develop and implement quality improvement initiatives

Greater New York Hospital Association and United Hospital Fund; http://www. gnyhafoundation.org/521/File.aspx

Fellowship in Patient Safety and Quality

Quality Scholars Program

Harvard Medical School; http://www.hms. harvard.edu/hfpsq/

2 years, 60+% of full-time effort

Funded

MD or DO and completed residency by start of fellowship

In-person instruction, assignment to process improvement project(s) ongoing within BJH, attend meetings of the Multidisciplinary PS and Quality Committee

Mentoring, share work nationally, attend the Medical Quality conference

Modality

2 years

15 months

(continued)

Didactics, shadowing, mentoring, hospital operational meetings and workgroups, and state and national conferences

In-person instruction, online instruction, and mentoring

In-person instruction, mentored 75+% of time research, research and during improvement conferences program (2-3 years)

1 Year

Training Length

Funded

Cost

Medical students and residents

Eligibility

Not listed Postdoctoral scholars Design, develop, test, sustain, scale, and share effective with pediatrics focus: interventions in care delivery medicine, surgery, Accurately measure health and care quality, cost and value public health, social Create and lead organizational/policy environments engaged sciences, nursing, in continuous improvement pharmacy, and allied Undertake research that creates new knowledge and health translates evidence of improved approaches to care in clinical, public health, and policy settings

Learn using a curriculum leading to an MPHS or an MS in clinical investigation from Washington University School of Medicine Hands-on training in health services research, administration, and PS operations Create a link with St Louis business community by incorporating courses in change management, marketing, and organizational development aimed at developing administrative skills with a focus on performance improvement Acquire skills in project management, Lean/Six Sigma methodology, rapid cycle improvement Understand structure for reporting and monitoring of sentinel and other PS events, as well as progress of performance improvement teams

Share your work and opinions and network with other motivated leaders

Objectives

Cincinnati Children’s-James M. Anderson Center for Health Systems Excellence; http://cincinnatichildrens.org/service/j/ anderson-center/education/default/

Patient Safety and Barnes-Jewish Hospital (BJH) and Quality Fellowship Washington University in St Louis School of Medicine; http://patientsafety.im.wustl. edu/Fellowship_Application.pdf

Fellowship Programs

Organizations

Table 2. Organizations Primarily Offering a Fellowship or PhD Focused on Health Care–Related Quality Improvement (QI) and/or Patient Safety (PS).


5

Fellowship Program

Institute for Healthcare Improvement; http://ihi.org

Comprehensive Patient Safety Leadership Fellowship

Full-time employment with supporting employer

Eligibility Funded by employer

Cost

Focus on foundational elements of PS, such as leadership roles, culture and communication, and incorporate them into 4 pillars of PS: care coordination, patientcenteredness, organizational culture, transparency Translate knowledge and best practices learned into action within their own organizations

Undergraduate and master’s degrees

Prior training and experience and/ or demonstrated interest in working to develop and implement PS initiatives

Funded

$14 500

Not listed Clinical training Acquire practical skills and tools to enhance PS in a health terminal degree system showing interest Understand the value of a systems-based approach to in PS, human problem solving based on human factors principles and factors, or creating understanding concept of “safety culture” in a health high-reliability system organizations as a Familiarize self with research methodology and its long-term career goal application in PS Conduct a project resulting in problem identification and solution implementation Participate in simulation trainings as a tool for systems safety Acquire leadership skills to enhance health care delivery safety in a health system

Develop the drive, skills, and experience to spread improvement in the United States and globally Gain competency in areas of leadership, models for improvement and improvement science, measurement, reliability science, communication, teamwork, project management, critical analysis tools, person- and familycentered care, business case for quality, public speaking, advocacy, proposal preparation, policy brief preparation, manuscript preparation, and regional solutions to optimizing population health, patient experience, outcomes of care, and cost of care

Objectives

Knowledge, skills, and methods in the following areas: Northwestern University Feinberg School PhD-Health care quality context and measurement, changing systems Care Quality and of Medicine-Center for Healthcare of care delivery and disparities, accountability and Patient Safety Track Studies; http://feinberg.northwestern.edu/ public policy, safety interventions and practices, health sites/chs/ information technology, simulation and the science of teamwork, human factors and risk assessment methods, leadership and governance, learn about environment shaping health policy, particularly in regard to quality and safety

National Patient Safety Foundation and American Hospital Association; http:// www.hpoe.org/PSLF/PSLF_main.shtml

Kaiser Permanente; http://residency.kp.org/ Patient Safety Fellowship ncal/fellowships/patient_safety/

Fellowship Programs

Organizations


At least 9 courses (4 years)

20% release time (1 year)

1 year

1 year (full time)

Training Length

(continued)

In-person instruction, mentoring, teaching

In-person and online instruction conferences, self- and organizational assessments, coaching

In-person and online instruction, mentorship

In-person instruction, mentoring, project teams, meetings, networking

Modality

6


Eligibility

Cost

Funded

Training Length

Learn how to conduct rigorous evaluations of medical Fellowship Program informatics applications and related interventions to in Health Care improve health care Quality and Medical Informatics

Funded Board eligible or certified physicians who have or are completing a relevant master’s degree

Abbreviations: ACGME, Accreditation Council for Graduate Medical Education; GME, graduate medical education; M&M, morbidity and mortality.

Weill Cornell Medical College-Center for Healthcare Informatics and Policy; http://weill.cornell.edu/chip/education/ fellowship-program.html

1 or 2 years

2 years

Funded Board certified or eligible physician, predoctoral nurse, postdoctoral nurse

VA Quality Scholars Learn to design, implement, manage, and monitor QI Fellowship Program systems Become competent in designing, conducting, and facilitating QI research that builds on validated clinical or health services research and development studies Gain working skills and knowledge in health care informatics, particularly the Veterans Integrated Systems Technology

US Department of Veterans Affairs; http:// va.gov/oaa/specialfellows/programs/ SF_NQSF_default.asp

10 courses (2 years)

6 months

1 year

17 courses (4 years)

Funded

Professionals interested Est. cost in quality and PS $6000

Familiarity with and interest in simulation education Track record for high integrity/ professionalism 2+ years completed in an ACGMEaccredited program

No explicit restrictions Funded

Physicians completing University of Pennsylvania-Perelman School Center for Healthcare Prepare for careers in health services and health policy residency or research related to care improvement in academic, Improvement and of Medicine-Center for Healthcare fellowship training government, community, and industry settings Patient Safety Improvement and Patient Safety; http:// (CHIPS) Fellowship Prepare for careers in health care administration or related www.med.upenn.edu/chips clinical leadership positions in which a broad knowledge of QI and PS science are increasingly needed

Quality and Safety Advocate for quality and safety Fellowship Program Understand the importance of quality and safety metrics Identify improvement opportunities Lead and implement quality and safety agenda to improve bottom-line results

University of Florida College of MedicineJacksonville; http://hscj.ufl.edu/patientsafety-fellowship/

University HealthSystem Consortium; https://www.uhc.edu/

Learning and leadership in applying: Principles of PS, including human factors and hazard analysis Measurement and monitoring of quality and safety Physician engagement in system initiatives Dissemination of improvement and innovation across a system Integration of PS into GME and undergraduate medical education (medical student) curricula—development of innovative ways to train physicians while holding PS and quality of care as paramount

Patient Safety Fellowship

University of Rochester Medical Center; http://www.urmc.rochester.edu/ education/graduate/phd/health-servicesresearch/program/research/patientsafety.cfm

Objectives Receive training about examining risks to PS, their root causes, and possible effective system approaches to prevent the occurrence of errors

Fellowship Programs

PhD in Patient Safety and Quality

Organizations

Table 2. (continued) Modality

Didactics, research-in-progress sessions, mentoring, work with Division of Quality and Medical Informatics and Center for Healthcare Informatics and Policy

In-person instruction with online augmentation (local and national curricula)

In-person instruction, mentoring, experiences in quality and safety, QI meetings, simulations, help lead a QI project

In-person instruction, conference calls, webcasts, coaching

Didactics, journal club discussions, committees, conferences (PS, M&M, own department)

Interdisciplinary courses, research and teaching activities


7

Other Programs

Three Faces of Quality

Patient Safety Leadership Data, structures, tools, and frameworks for the following: PS and QI Training and Evidence-based executive rounding Certification Course Psychological safety and safety culture Teamwork and dealing with difficult colleagues Second victim of harm Pacing change in sustainable ways

Duke University Health System Patient Safety Center; http:// dukepatientsafetycenter.com/

Focus on work and/or process improvement and outcomes management in the clinical and business environment

Graduate Certificate in Quality Improvement and Outcomes Management

Barry University College of Health Sciences; http://www.barry.edu/ hsacertificate/

No explicit restrictions

Bachelor’s degree and relevant health care/health services professional experience


26 hours (3 days)

12 credits

Est. cost $11 880

$2000

4 days

$1150 to $1300

(2) Same as above

(1) 32 hours

(1)$900 to $1000

(1) Employed in health care, (1) Hone skills in the following: have a bachelor’s degree Organizational development in a health-related field, Health care quality management or extensive health care Team building experience at managerial Problem-solving techniques and process improvement level Learn how to assess, measure, plan for, and improve quality in your organization (2) Understand how to effectively meet requirements of a PS (2) Same as above program and implement national and international PS goals Understand effective resource use by developing strategies based on patient and clinical risk Develop a comprehensive PS program for your department, unit, or institution

(continued)

In-person instruction



(1) In-person instruction (2) Same as above (2) Same as above

24 hours—over 3 In-person or online instruction days (in person) or 6 weeks (online)

On-site instruction, workshops

Modality

$1450 to $1745

Build scientific capacity and apply evidence to improve care and patient outcomes Experience a full immersion in the latest advances in care improvement Take advantage of back-to-back conferences to improve care and patient outcomes, from research to implementation to outcomes

2-5 days

Training Length

See what you, as a physician leader, need to guide your team No explicit restrictions in support of high-quality care Learn performance improvement tools to deliver higher quality health care and ensure PS Gain a better understanding of how a culture of high reliability can help your organization prevent, detect, and mitigate errors Outline a plan for returning to your institution and initiating QI efforts Influence physician behavior to improve quality and costeffectiveness

Cost $700 to $1325

Eligibility No explicit restrictions

Objectives

ASHRM Academy-Patient Understand and apply your key contributions to improved American Society for Healthcare patient care and outcomes Safety Certificate Risk Management (ASHRM); http:// Program www.ashrm.org/ashrm/education/ programs/patient_safety/program. shtml

(1) Certificate in Health American Institute for Healthcare Care Quality Quality; http://aihq.javelincms.com/ products/certification/certificate-inpatient-safety/ (2) Certificate in Patient Safety

American College of Physician Executives; http://www.acpe.org/ education

Academic Center for Evidence-Based Summer Institutes on Quality Improvement Practice, Improvement Science Research Network, and University of Texas Health Science Center San Antonio; http://www.acestar.uthscsa. edu/institute/su13.asp

Organizations

Table 3. Other Organizations Offering Other Programs Focused on Health Care–Related Quality Improvement (QI) and/or Patient Safety (PS).

8


Other Programs

Eligibility

Quality Improvement and Acquire the knowledge and ability to work in interdisciplinary Bachelor’s degree with 3.0+ GPA care teams using tools and techniques of statistical process Outcomes Management control, and selected methods and tools from operations in Health Care Systems research and QI Graduate Certificate Use information management technology and qualitative decision-making applications to identify opportunities for clinical and administrative improvement, support decisionmaking optimization, and improve health-service outcomes for identified populations

Bachelor’s degree with 2.75+ Learn key concepts in monitoring, evaluation, and sustaining GPA QI efforts in care settings Study theories, strategies, and research related to QI in health care systems Synthesize previous learning and function in a role of QI specialist under mentorship of select expert preceptors

Objectives

(1) 20-Day Course Intermountain Healthcare Institute for Executives & QI for Health Care Delivery Research; Leaders—Advanced http://intermountainhealthcare.org/ qualityandresearch/institute/courses/ Training Program atp/Pages/home.aspx (2) 9-Day Course for Practicing Clinicians— Mini Advanced Training Program

(1) No explicit restrictions (1) Understand and have tools to conduct state-of-the-art clinical practice improvement projects Use QI methods to manage and integrate nonclinical processes Implement QI programs Conduct internal QI training Opportunity to join a national/international network that provides ongoing support and information sharing for future collaborations (2) No explicit restrictions (2) Understand and have tools to conduct state-of-the-art clinical practice improvement projects Use QI methods to manage and integrate clinical processes

(1) Gain basic knowledge in areas of improvement capability, (1) No explicit restrictions Institute for Healthcare Improvement (1) IHI Open School PS, leadership, person- and family-centered care, quality, (IHI); http://ihi.org Basic Certificate of cost, and value Completion (2) No explicit restrictions (2) Develop or refine detailed, customized strategies and (2) Patient Safety implementation plans, and learn how to effectively advise and Executive Development Program coordinate the plans with senior leadership (3) No explicit restrictions (3) Summer Immersion (3) Understand the theory, application, and benefits of IHI’s mission and strategy Identify novel processes for improvement to bring home to your organization Meet others from around the world who also are dedicated to improving health care

George Mason University; http:// catalog.gmu.edu/preview_program. php?catoid=19&poid=18011&retur nto=4105

Graduate Certificate in Eastern Michigan University; http:// catalog.emich.edu/preview_program. Quality Improvement in Health Care php?catoid=17&poid=7933

Organizations


(2) In-person (2) 9 days staggered over 4 instruction months (continued)

(3) In-person instruction, meetings, networking

(2) $6000

(3) 5 days

(3) $2950


(1) In-person (1) 20 days staggered over 4 instruction months

(2) 7 days

(2) $10 500


In-person and online instruction


Modality

(1) $10 500

(1) 8 hours (16 courses)

15 credits

12 credit hours

Training Length

(1) $0 to 300

Est. cost $8373 to $18 626

Est. cost $7070 to $12 499

Cost


9

Other Programs

Eligibility

(1) Patient Safety Certificate Program

(2) No explicit restrictions (2) Leadership in Patient (2) Proactively identify and mitigate risks, develop a Safety and Quality systematic approach for robust process improvement, provide infrastructure for successful safety initiatives, manage innovation and creativity, use data to guide decisions and drive improvement, and learn strategies for improving culture, patient, and family engagement, and multidisciplinary teamwork to further PS and quality objectives

(1) No explicit restrictions (1) Create and sustain a PS culture focused on patientcentered care, apply evidence-based practices to develop and support effective multidisciplinary teams who partner with patients and their families to improve PS outcomes, use a systems-based approach to identify and mitigate defects, develop PS initiatives for real and lasting change, act as change agents in your organization as you lead efforts to continuously learn from defects and improve PS and quality care

Bachelors degree, a strong Learn frameworks and theories to assess and improve quality of record of successful care, understand current key policy and programmatic areas in academic performance, and quality of care, understand how to assess quality of care, describe 3+ years of professional key elements of published quality assessment and improvement experience in health care studies, and understand how to develop a workable QI and evaluation plan Recognize extent of problems in PS in medical care, describe role of various systems and factors in creating safety and causing errors and adverse events, discuss problems and issues in measuring and reporting safety, demonstrate knowledge of the basics of conducting an incident investigation and disclosing an adverse event, design solutions to improve PS, and understand the ethical, legal, and regulatory implications related to PS Learn the importance and challenges of using patient- and consumer-reported measures in research, clinical practice, and program evaluation, compare different types of instruments available to measure health-related quality of life, critique use of commonly used patient-reported outcomes in specific applications, plan development of a questionnaire, understand the role of patient-centered outcomes research in improving health and its place in the US research portfolio, understand the importance of stakeholders in the research process, policy implications related to implementation, and identify study designs and methodologies unique to patient outcomes research

Objectives

Johns Hopkins Medicine-Armstrong Institute for Patient Safety and Quality; http://www. hopkinsmedicine.org/armstrong_ institute/

Johns Hopkins-Bloomberg School of Quality, Patient Safety and Outcomes Public Health; http://www.jhsph. edu/academics/certificate-programs/ Research Certificate certificates-for-hopkins-and-nondegree-students/quality-patientsafety-and-outcomes-reserach.html

Organizations

Table 3. (continued) Modality

(1) 5 days or 13 modules

(continued)

(1) Interact with experts, group activities (eg, case studies, simulations, design sessions, panel discussions), network with other participants and course leaders (online option also available) (2) In-person instruction

21 Credits (up to 3 In-person and years) online instruction, mentored practicum

Training Length

(2) Two, 4-day (2) $5000 for 1 session, $8000 for 2 events sessions

(1) $495 to $2995

Est. cost $20 034

Cost

10


Completion of lean 200H, Learn methods to facilitate measurable improvements in lean 300H, and lean productivity, quality, and capability assessment Learn methods to improve quality, reduce costs, and improve patient satisfaction Become familiar with a proven pathway to lean transformation Begin a long-term culture of sustainable continuous improvement Become an experienced, in-house, lean health care leader/ mentor

Lean Healthcare Certificate Program

$1995

Est. cost $595

NC State University; http://ies. ncsu.edu/solutions/operationalexcellence/lean-health-care/leanhealth-care-certificate-program/

$199 to $399


No explicit restrictions Understand and have tools to work successfully with a new quality and PS process, requirements, and timetable Ability to create an action plan that will outline key initiatives to be taken with respect to PS implementation in your own organization

(7) $8000 or $14 000

(7) 3+ years work experience as a clinician or administrator

Quality and Patient Safety Certificate

Equip with the foundational knowledge necessary to understand the context, key principles, and competencies associated with the discipline of patient safety, and how these tenets and skills are applied in everyday practice

(5) $1395

(5) No explicit restrictions

(6) $995

(4) $3995



(3) $995

Cost


Eligibility

National Quality Colloquium; http:// qualitycolloquium.com/certificate. html

Patient Safety National Patient Safety Foundation; http://www.npsf.org/online-learning- Curriculum center/patient-safety-curriculum-2/

(4) Use DMAIC project methodology, apply concepts learned to a lean sigma health care project, practice sound data collection and data analysis techniques, demonstrate a basic understanding of statistical methods, and organize and lead a lean sigma project (5) Able to enumerate and communicate the importance of (5) Evaluating Quality understanding environmental, organizational, group, provider, Improvement and task, work system, implementation, and patient influences Patient Safety Projects on outcomes, able to describe and evaluate strengths and weaknesses of designs for testing success of QI/PS interventions, able to describe operational steps to conducting robust data collection and analysis, and able to define and describe remedies for common problems in QI/PS studies (6) Recognize the role that human factors play in identifying (6) Improving Patient and mitigating PS hazards, identify problems in your own Safety with Human workplace that would benefit from a human factors Factor Methods engineering approach, become familiar with human factors methods for evaluating medical devices and health information technology in a systematic way, and sample human and ergonomics tools that can be applied in a broad range of care settings (7) Patient Safety (7) Learn concepts and practical skills needed to lead patient Fellowship safety efforts

(4) Lean Sigma Prescription for Healthcare

(3) Identify and reduce or eliminate waste in care delivery processes

Objectives

(3) Lean for Healthcare

Other Programs

Organizations


Up to 2 years

31 hours

10 modules

(7) 4 months or 9 months

(6) 2 days

(5) 2.5 days

(4) 1 week

(3) 2 days

Training Length

(continued)

Coaching, mentoring, and hands-on, learnby-doing

Online or in-person instruction

Online instruction

(7) In-person instruction, mentored project, practicum

(6) In-person instruction, hands-on exercises/examples


(3) In-person instruction, interactive workshops (4) In-person instruction

Modality


11

Other Programs

Objectives

Quality and Safety Educators Academy

(1) Est. cost $4305 to (1) 15 credits (1) Full- or part-time $23 605 graduate student and experience, degree, or course work in health care (2) No explicit restrictions (2) $2000 (2) Up to 1 week

(2) Short Course

Abbreviations: DMAIC, define, measure, analyze, improve, control; GPA, grade point average.

(2) Understand human factors and systems engineering and how this approach to PS can improve system performance and safety, prevent harm when error does occur, and help systems recover from error and mitigate further harm

(1) Increase knowledge about how systems engineering and systems design can be used to identify, analyze, and solve PS research and applied problems

(1) Patient Safety Certificate

12 units

University of Wisconsin-Center for Quality and Productivity Improvement; cqpi.engr.wisc.edu

Est. cost $18 732

Online instruction

In-person instruction, mentoring, networking

In-person or online instruction

Modality

(2) Didactics with active participation

(1) Course instruction

Online, in-person instruction, or blended

15 semester credit In-person instruction hours Bachelor’s degree

Est. cost $7062 to $16 317


Certificate in Patient and Prepares risk managers and pharmacovigilance experts for Product Safety professional careers in which medical products and facilities interact with people to create high-risk situations that need to be anticipated and controlled Evaluation and mitigation of medical errors and health care product problems

Ability to analyze and solve complex problems Ability to deploy quality- and safety-focused strategies for your organization

12 credit hours

2.5 days

12 credit hours (four 8-week courses)

Training Length

University of Southern California; https://regulatory.usc.edu/ files/2013/11/CertificateinPatient_ Product_Safety_Flyer.pdf

Healthcare Quality UAB School of Health Professions; http://uab.edu/shp/hsa/hqs-certificate and Safety Graduate Certificate

Est. cost $7524

$1950

Est. cost $7140

Bachelor’s degree with a 3.0+ GPA and 2+ years of health care experience

Exposure to network of colleagues who are engaged in similar No explicit restrictions educational work at their institutions Acquire a repertoire of curriculum ideas to implement Leave with a toolkit of resources and tools for quality and safety education Exposure to online modules developed by SHM’s QI Education Committee

Cost

Eligibility

No explicit restrictions Southern New Hampshire University; Patient Quality and Safety Develop continuous improvement of patient care process Graduate Certificate through analysis and measured change to current clinical http://snhu.edu/online-degrees/ programs in the inpatient and outpatient environments graduate-certificates/patient-qualityIntegrate the use of communication skills, information systems, safety-online.asp and standardized language in relation to clinical outcomes and continuous performance measures Develop research and education programs to advance the national PS agenda Create PS and patient care outcomes through educational programs Evaluate the effectiveness of continuous improvement processes

Society of Hospital Medicine (SHM) and Alliance for Academic Internal Medicine; http://sites. hospitalmedicine.org/qsea

Health Care Quality and Learn basic QI theory Regis University; http://regis.edu/ Patient Safety Graduate Gain knowledge of tools to measure statistical change RHCHP/Academics/Degrees-andImprove leadership skills to implement PS/performance Certificate Programs/Certificates/Health-Careimprovement initiatives Quality-and-Patient-Safety.aspx

Organizations


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American Journal of Medical Quality

relevant field. These distinctions were made because of significant differences in the structures and audiences of the programs. To highlight these differences, each program was characterized with regard to name of degree, Web site–delineated educational objectives for participants, educational and experiential eligibility requirements, cost of attendance, length of training, and training modalities (ie, formats of educational experiences). When not explicitly listed in total, course cost was estimated by incorporating both per credit/course costs and fixed fees greater than the cost of a single credit/course (eg, general student services fee). Smaller fixed fees (eg, application fees, information technology fees, graduation fees) were not included in any estimation. Ranges were provided in cases of price discrimination for residency status, educational status, organizational membership status, and military status, but not for group discounts. The data obtained from Tables 1, 2, and 3 show commonalities within each given program group as well as commonalities and contrasts among the 3 groupings. There is significant overlap among the objectives of many of the programs (eg, leadership training, metrics training). A program advertising specific capabilities, such as learning lean methodology or organizing an improvement project, may communicate a better value proposition to potential applicants than a program with vague or generic descriptions. A significant number of “other” programs have no specific eligibility prerequisites, whereas most of the master’s degree and fellowships/PhD programs require an educational or skills baseline. In most of these cases, suggestions of a target audience are typically made in lieu of requirements. Costs for fellowships typically are not borne by the participant, while master’s degree and “other” programs have a wide range of costs paid by the participant, starting at hundreds of dollars and extending to nearly 6 figures. Quite reasonably, the higher priced programs are predominantly lengthier programs. Most of the “other” programs could be completed in less than 1 month, whereas most of the master’s and fellowship/PhD programs require 1 to 2 years. Although master’s, certificate, and “other” programs are skewed toward online instruction, fellowship/PhD programs are predominantly structured for in-person instruction. Despite intragroup commonalities, it should be noted that significant heterogeneity existed with regard to Web site appearance and organization of information. The continuously changing landscape of training programs and search engine optimization limit the potential of complete inclusivity of programs in this compendium. New institutional involvement, new programs within already involved institutions, and changes to existing programs make updating data a frequent necessity. On the other hand, changes to existing

programs are likely to consist predominantly of small and regular increases in costs and minor adjustments to curriculum length and content. This suggests that an aggregation such as the one herein would provide a useful origin for program search. Sharing of these data in a public, editable format (eg, an open Google spreadsheet) would allow program leaders to proactively keep information about their program current while providing open access to prospective enrollees. The availability of this interaction could ultimately lead to collaboration of program leaders, and even interested health care leaders, on new educational and/or clinical QI and PS initiatives. Furthermore, a preliminary search suggested a vast array of international options for QI/PS training. A compilation of international programs may be performed in the future to benefit health care workers outside of the United States. The wealth of information included herein will prove useful to many individuals. This compilation is a new, extensive resource for all those interested in health care QI and PS. For clinicians interested in building their QI and PS skills, these tables provide easy targeting of programs for those with time, monetary, or geographic restrictions. Furthermore, residency directors and mentors may find this information valuable when advising residents interested in pursuing additional QI and PS training. This information also provides an assortment of program options with more accommodative admissions for those who are interested in quality and safety, but who may not have advanced academic credentials. For professionals involved with administrating an academic program focusing on QI and PS, these tables provide comparisons upon which to consider training program adjustments and Web site display modifications. Ultimately, this compilation displays a snapshot of the current environment for QI and PS health care training programs and offers interested professionals an additional tool with which to make their own mark on the US health care system. Declaration of Conflicting Interests The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The authors received no financial support for the research, authorship, and/or publication of this article.

References 1. James JT. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf. 2013;9:122-128. 2. US Congress, 111th Session. Patient Protection and Affordable Care Act of 2010. http://www.gpo.gov/fdsys/


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Karasick and Nash pkg/PLAW-111publ148/pdf/PLAW-111publ148.pdf. Accessed March 2, 2014. 3. American Board of Medical Specialties. MOC competencies and criteria. http://www.abms.org/Maintenance_of_Certification/ MOC_competencies.aspx. Accessed May 13, 2014. 4. Accreditation Council for Graduate Medical Education. Clinical Learning Environment Review (CLER) Program.

http://www.acgme.org/acgmeweb/tabid/436/Programand InstitutionalAccreditation/NextAccreditationSystem/Clinical LearningEnvironmentReviewProgram.aspx. Accessed May 13, 2014. 5. Baron RB, Davis NL, Davis DA, Headrick LA. Teaching for quality: where do we go from here? Am J Med Qual. 2014;29:256-258.


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