The Emory Experience: Quality Improvement Skills Labs in Interdisciplinary Education
By Ariadne K. DeSimone
In spring 2014, one day after taking my Step 2 Clinical Knowledge of the United States Medical Licensure Examination (USMLE), I finally had time to turn my attention to thoughts about my future and to the email messages that had accumulated over the past month. One announcement stood out: The Emory University Institute for Healthcare Improvement (IHI) Open School chapter was seeking applications for its leadership team. With plans to begin the Master of Public Health (MPH) in Health Policy and Management program at the end of the summer, between my third and fourth years of medical school, I was searching for extracurricular opportunities that would complement my studies. In that moment, as I read the email solicitation, I took a leap of faith. I had never heard of IHI, yet within a week I had applied, interviewed, and accepted a position as director of education for Emory’s chapter of IHI Open School. I was compelled to act so spontaneously by what I understood to be the vision, mission, and approach of IHI: to work with health systems and other organizations around the world to improve healthcare quality, safety, and value.
How could I presume to be a leader of a group focused on quality improvement (QI) if I was brand-new to the field? I had a lot to learn, and fast. I dedicated the next several weeks to taking all 16 of the IHI Open School online courses. I learned about the Model for Improvement, which involves asking three fundamental questions:
- What are we trying to accomplish?
- How will we know a change is an improvement?
- What changes can we make that will result in improvement?
Next, the model calls for testing changes with Plan-Do-Study-Act (PDSA) cycles. I worked my way through lessons on improvement projects, beginning with a discussion of the importance of innovation, followed by pilot, implementation, and spread. Later I studied the fundamentals of patient safety, human factors, teamwork, and communication. Finally, I was introduced to the concepts of quality, cost, and value in healthcare.
My own curiosity, as well as my desire to inspire other students, motivated me to collaborate with members of our leadership team to organize twice-monthly lectures on QI and patient safety. Open to graduate students of medicine, public health, nursing, allied health, and business at Emory University, the lectures are just as much for my own edification as for my fellow students. Additionally, we developed a monthly Quality Improvement in Clinical Practice lecture series. Designed to dovetail with the first- and second-year medical school curriculum, we invite a physician with research and clinical interests in QI to speak to our group. We have also organized a surgical QI journal club during which students and general surgery residents meet over lunch to discuss a recent journal article and learn how it relates to current surgical practice at Emory. We also work alongside Emory’s Healthcare Innovation Program and the Goizueta Healthcare Association at Emory’s Goizueta Business School to send students to their symposia. Finally, we encourage and support students to take the IHI Open School online courses.
What else, I wondered, could a unique interdisciplinary student organization like ours provide the Emory community? I began asking other graduate students what would draw their attention. Almost everyone expressed interest in events designed to impart certain specific skills as well as opportunities to learn and apply these skills alongside students from a range of disciplines.
Later that summer, I pitched the idea of hosting a half-day QI training session to our leadership team, something concrete that would spark critical thinking about healthcare systems and provide students with applicable QI skills. The team loved the idea, and for the next few months, I and two fellow chapter leaders, Erin Bredenberg (an MD/MPH candidate in the class of 2015) and Tana McCoull (an MSN candidate in the class of 2016), worked to make it happen.
Designing and implementing a graduate QI training essentially from scratch created many challenges, and although each of us had previous teaching experience, we knew we couldn’t pull it off alone. For help, we turned to some of our mentors and accomplished teachers of QI at the Atlanta VA Medical Center, including the chief of quality for medical specialty service and the fellowship site director of the VA Quality Scholars Fellowship Program, the VA Quality Scholar fellows, and the chief resident of quality and patient safety. They were as enthusiastic as we were about the potential of the training day.
During our first planning session, Erin, Tana, and I settled on several goals and objectives for the program. We decided that the overall purpose of the Healthcare Quality Improvement Training Day & Skills Lab would be to inspire critical thinking about healthcare systems and to equip graduate students with QI skills that they could apply to their current and future work.
Next, we developed a demanding curriculum of three hour-long, student-led sessions. As a starting point, we referred to the IHI Open School online courses, in addition to activities from the IHI Open School 5th Annual Student Quality Leadership Academy and The Academy for Emerging Patient Safety Leaders: The Telluride Experience. We created pre- and post-tests to assess the success of our event. Finally, we arranged all of the logistics, including reserving rooms in the medical school, buying supplies, and securing funding for breakfast and lunch from IHI Open School and the Emory Graduate Student Senate.
Within the first 24 hours of publicizing our training day, more than 60 students inquired, and within a few more days, more than 100 had asked to attend. In the end, we accepted 50 students—10 each from the medicine, public health, nursing, allied health, and business graduate programs at Emory.
In the month preceding the event, we finalized the curriculum, prepared materials, and divided the participants into 10 interdisciplinary teams. We thought this would be an essential organizing principle in fostering engaging conversations and camaraderie among members of different healthcare fields.
On Saturday, November 8, 2014, we welcomed 50 students into the School of Medicine lecture hall. In the first session, they met in small groups to discuss healthcare case studies and explore the human factors that typically lead to errors. In the second session, the skills lab portion, they practiced writing aim statements and participated in a hands-on team-building exercise illustrating the stages of a PDSA cycle. Finally, they created flow charts of simple everyday processes and were introduced to the idea of applying change concepts.
At the end of the day, Erin and I reviewed the pre- and post-tests and discovered that all 50 participants wanted to participate in a second training day in the spring. This was great news, and it represented a big win.
Once the spring semester arrived, we began organizing two more interdisciplinary skills labs. The first, designed for students new to QI, focused on applying the PDSA cycle to a team-based activity. The second skills lab introduced more seasoned students to Six Sigma tools and techniques for process improvement. More than 20 students attended each of the sessions. We have proven that this interdisciplinary skills lab model works and plan to offer similar sessions at Emory this coming school year.
As I reflect on the past year, I feel as if I have a greater sense of clarity and direction, and for that I have IHI and IHI Open School to thank. I was recently elected to serve as co-president of IHI Open School Emory this coming year. I was selected to attend The Academy for Emerging Patient Safety Leaders: The Telluride Experience in July. I will continue with research projects related to quality improvement and patient safety for Emory’s department of radiology and imaging sciences. Then, in 10 years or so, I can imagine myself in an academic position in the field of radiology or neurology, working as a clinician, teacher, and researcher, and still—always—involved in QI.
Ariadne K. DeSimone is an MD/MPH candidate (class of 2016) at the Emory University School of Medicine in Atlanta. She may be contacted at ariadne.desimone@emory.edu.