Quality Improvement Training for Healthcare Professionals

Evidence scan: Quality improvement training for healthcare professionals August 2012 Identify Innovate Demonstrate Encourage Contents Key messages 3 1. Scope 6 2. Examples of training 10 3. Most effective approaches 27 4. Important messages 33 References 39 Health Foundation evidence scans provide information to help those involved in improving the quality of healthcare understand what research is available on particular topics. Evidence scans provide a rapid collation of empirical research about a topic relevant to the Health Foundation's work. Although all of the evidence is sourced and compiled systematically, they are not systematic reviews. They do not seek to summarise theoretical literature or to explore in any depth the concepts covered by the scan or those arising from it. This evidence scan was prepared by The Evidence Centre on behalf of the Health Foundation. © 2012 Health Foundation Key messages There is an increasing focus on improving healthcare in order to ensure higher quality, greater access and better value for money. In recent years, training programmes have been developed to teach health professionals and students formal quality improvement methods. This evidence scan explores the following The training approaches most commonly questions: researched include: – What types of training about formal quality – university courses about formal quality improvement techniques are available for improvement approaches health professionals? – teaching quality improvement as one component – What evidence is there about the most of other modules or interspersed throughout a effective methods for training clinicians in curriculum quality improvement? – using practical projects to develop skills – online modules, distance learning and printed For the purposes of this scan, quality improvement resources training was defined as any activity that explicitly aimed to teach professionals about methods that – professional development workshops could be used to analyse and improve quality. – simulations and role play Courses about techniques, such as evidence-based – collaboratives and on-the-job training. medicine, statistics and leadership, were included if the stated aim was to improve quality. Courses about improving a specific condition or pathway Training content were included if they incorporated material about In much of the Western world, quality improvement techniques that could also be widely improvement modules for medical and nursing applied to other topics. students tend to focus on techniques such as audit and plan, do, study, act (PDSA) cycles. Most Ten electronic databases were searched for research courses run by academic institutions tend to be published between 1980 and November 2011 and 367 unidisciplinary and classroom based or undertaken studies were summarised. Sixty higher educational during clinical placements. However, there is institutions and other organisations in the UK and an increasing acknowledgement of the value of internationally were contacted for course curricula. multidisciplinary training, especially in practical Unless otherwise specified, the trends reported are work-based projects. Many courses now contain a evident throughout the Western world. practical component. Simulation is also becoming popular as a training approach. Types of training Continuing professional development training Training in quality improvement is available for about quality improvement appears to be growing medical, nursing and paraprofessional students in at a faster rate than university education. Ongoing many parts of the world. Continuing professional education includes workshops, online courses, development (CPD) courses are also available, collaboratives and ad hoc training set up to support including short workshops, on-the-job training and specific improvement projects. There is a growing training related to specific projects. trend for training which supports participants to put what they have learned into practice or to learn key skills ‘on the job’. THE HEALTH FOUNDATION Evidence scan: Quality improvement training for healthcare professionals 3 There are some geographic variations in the content Training effectiveness of formal courses and CPD programmes. In the US and to a lesser extent Canada, quality improvement Impact of training is conceived largely as a ‘total quality management’ A great deal has been written about training paradigm and training focuses on collating professionals to improve quality in healthcare. predominantly quantitative information. In the UK, In fact, more than 5,000 articles were identified a patient safety and change management approach is about this topic. However, the majority merely more common. To some extent the US approach is describe training approaches and content, rather more standardised and rigid and the UK approach is than examining the impacts of training or the most more open and less consistently applied. useful content and training methods. Courses in the US tend to focus on ‘named’ There is some evidence that training students and approaches such as PDSA cycles. Practical health professionals in quality improvement may projects are increasingly common. In Canada and improve knowledge, skills and attitudes. Care Australasia, training about quality improvement processes may also be improved in some instances. also emphasises putting theoretical concepts However, the impact on patient health outcomes, into practice using work-based projects. In the resource use and the overall quality of care remains Netherlands and Scandinavia there has been uncertain. more focus on mentorship and peer review, whereas in the UK training tends to concentrate Most evaluations of training focus on perceived on specific components of quality improvement, changes in knowledge rather than delving deeper such as leadership and safety. In recent years, UK into the longer-term outcomes for professionals courses have started to recognise the importance and patients. Programmes which incorporate of population health and risk assessment, but practical exercises and work-based activities are relatively few programmes emphasise the needs increasing in popularity, and evaluations of these and perspectives of service users in any real depth. approaches are more likely to find positive changes in care processes and patient outcomes. In the US, training in quality improvement is mandatory for medical students. In contrast, in There is not a body of evidence assessing whether the UK, until recently there was less focus on training professionals is any more or less effective training students in quality improvement and for improving the quality of healthcare than other little integration of quality improvement concepts initiatives. into pre-qualification courses. This is beginning to change, with more time now spent on concepts Effectiveness of different methods such as evidence-based medicine, audit and Few studies have directly compared different improving safety. training methods. This means that there is insufficient evidence to conclude whether classroom In England, arms length bodies, workforce formats, practical projects, online modules or other deaneries and strategic health authorities methods are more or less effective. However, active run quality improvement courses for health learning strategies, where participants put quality professionals. Activity in this area has increased improvement into practice, are thought to be more in recent years. There is no consistent content or effective than didactic classroom styles alone. definition of quality improvement, but there tends to be a common approach which involves using It appears important to include quality practical, rather than simply didactic, methods. improvement methods in both pre-qualification training and CPD. It is also important to upskill trainers so that they can teach quality improvement methods robustly. THE HEALTH FOUNDATION Evidence scan: Quality improvement training for healthcare professionals 4 In recent years, the concept of quality improvement has become more widely accepted in the UK and training is increasingly available, especially for qualified professionals. However, a great deal remains uncertain about training in quality improvement, including: the most appropriate content; how training can best be delivered to improve processes and patient outcomes; how to measure and ensure quality within training. This is an essential area for further exploration. Training professionals may be important not only to ensure that they have the skills needed to improve the quality of healthcare, but also to enhance their motivation to do so. THE HEALTH FOUNDATION Evidence scan: Quality improvement training for healthcare professionals 5 1. Scope For hundreds of years, clinicians have sought to make healthcare more effective and accessible. Recently, health professionals have begun to learn about formal methods to improve quality. This evidence scan summarises research about the types of training available and its impacts. 1.1 Purpose learn and apply new skills. The Health Foundation believes that training can be an effective lever for ‘Not all changes are improvements but all improving the quality of healthcare. Yet education improvement involves change. Changing and training initiatives are not always prioritised by the systems that deliver care has thus policy makers or practitioners.5,6 become the cornerstone of the movement that is now referred to as medical quality ‘While healthcare organisations are improvement.’1

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