Vanderbilt University

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1 Fundamentals of Quality Improvement in Health Care: An Interdisciplinary Elective OBJECTIVE The elective course, Fundamentals of Quality Improvement in Health Care, will provide students with an introduction to quality improvement science in a health care setting. The course will challenge students to think in an interdisciplinary manner when problem solving for quality improvement and will provide students with models and teambuilding strategies for leading quality improvement initiatives in a variety of organizational settings. DESCRIPTION Students from the Schools of Management, Medicine, and Nursing will work together as a class and in teams of 5-6 throughout the course to facilitate interdisciplinary learning. Topics to be covered in the course include: fundamentals of quality improvement science, leadership and teambuilding for quality improvement, change management, organizational design for the continuous learning organization, using information technology to improve quality, and the business case for quality improvement. Students will also hear from a family affected by a significant medical error; visit the Vanderbilt University Hospital Emergency Department to practice mapping process flow in a delivery setting; and sit in on a departmental Morbidity, Mortality, and Improvement (MM&I) conference. Each session will be led by a different speaker who is an expert in the topic of the class. Class Hours & Location: Faculty Directors: Student Managers: Tuesdays, 5:30pm- 7:30pm Godchaux Hall, Nursing Annex Room 165 Fall semester, 2010 Aug 31- Dec 7 Carol Callaway- Lane, RN, MSN, ACNP- BC (School of Nursing) Jacob Hathaway, MD, MPH (School of Medicine) Rangaraj Ramanujam, PGDM, PhD (Owen School of Management) Natalie L. Ausborn (Class of 2013, School of Medicine) Janice Babbs (Class of 2011, Owen School of Management) Amanda M. Brantley (Class of 2011, School of Nursing) Benjamin Ferrell (Class of 2011, School of Nursing) Scott L. Hagan (Class of 2013, School of Medicine) J. Matthew Kynes (Class of 2011, School of Medicine) D. Timothy Lockney (Class of 2013, School of Medicine) D. Jacob McClure (Class of 2013, School of Medicine) Julie McNeil (Class of 2011, Owen School of Management) Piotr P. Pilarski (Class of 2011, School of Medicine) Irving Ye (Class of 2012, Owen School of Management/School of Medicine) 1

2 COURSE MATERIALS Readings will be posted on the course Blackboard (BB) site: MGT- 459W- 01_Health Care Quality Improvement Additional required course materials must be purchased by Tuesday, September 21. Total Cost: $6.00 HBR Case Studies - Children s Hospital & Clinics, Virginia Mason Medical Center, and Cincinnati Children s Hospital Students are also strongly encouraged to complete the related listed for each week. IHI Open School courses can be found here: Open School Course Catalog GRADING Attendance MM&I Conference Reflection Final Team Presentation 50% 10% 40% ATTENDANCE No more than two classes may be missed during the course of the semester. Students must notify the course administrator, QIElective@owen.vanderbilt.edu, of any absences prior to missing class. ASSIGNMENTS AHRQ Web M&M Cases: Read 6 AHRQ Web M&M cases (2 per session) that will be discussed during the second hour of 3 course sessions (weeks 2, 6, and 7) Divide into interdisciplinary groups and discuss each case for 15 minutes, answering the following questions: o What went wrong in this AHRQ case? o How can the issues be resolved? (Consider your respective schools of thought) o What barriers exist towards implementing your proposed solutions? (Consider your respective schools of thought) Discuss the cases in a moderated large- group session 2

3 MM&I Conference Reflection: Attend at least one of the three MM&I conferences at Vanderbilt University Medical Center listed below Complete a short written reflection on Blackboard (post your reflection on the MM&I conference blog) describing what you learned at the conference and how you think the topics covered in this course could help prevent/improve the outcome Conferences will be discussed in class on the following Tuesday Friday, September 10 Friday, November 5 Friday, December 3 Department of Surgery Department of Medicine Department of Surgery 6:30am 8:00am 12:00pm 1:00pm 6:30am- 8:00am Light Hall 208 Light Hall 411 A- D Langford Auditorium **breakfast at 6:00am **bring your own lunch **breakfast at 6:00am Final Team Presentation: Teams are randomly assigned one of four case studies offered by the Institute for Healthcare Improvement Open School for Health Professions: o An Insulin Overdose o Knowing is Not Enough o The Crowded Clinic o The Unfortunate Admission Discuss and conduct root cause analysis of case, identifying the multiple causal factors contributing to the outcome or challenge posed by each case Choose a specific area for improvement from case study; apply and answer the three questions of the fundamental Model for Improvement (The Improvement Guide, API, 2009): o What are we trying to accomplish? o How will we know that a change is an improvement? o What change can we make that will result in improvement? Design a Plan, Do, Study, Act (PDSA) Cycle for the specific area identified for improvement Provide 10- minute presentation on case analysis and improvement design to the entire class 3

4 SCHEDULE Week 1 (8/31) Introduction to Quality Improvement Establish historical context and introduce the modern- day science of quality improvement Lecture by Warren S. Sandberg, MD, PhD Chair and Professor in the Department of Anesthesiology at Vanderbilt University Medical Center Introduction to course review of syllabus Report Brief of To Err is Human Report Brief of Crossing the Quality Chasm Transforming Healthcare: A Safety Imperative PS 100 Introduction to Patient Safety Week 2 (9/7) Contemporary Quality Improvement & Patient Safety Initiatives Provide examples of quality improvement initiatives in health care delivery settings Lecture by Jane Englebright, PhD, RN CNO & VP of Clinical Performance at Hospital Corporation of America Assignment of teams AHRQ team case review, analysis, and discussion AHRQ Web M&M Cases Code Blue Where to? It s All in the Syringe Improving Safety with Barcode-Enabled Medication Administration PS 101 Fundamentals of Patient Safety QI 101 Fundamentals of Improvement 4

5 Week 3 (9/14) The Business Case for Quality Facilitate an understanding of how quality is defined within a health care organization and within the health care industry as a whole Evaluate elements of the 2010 health care reform bill that address quality improvement Lecture by Thomas Bartrum, JD Shareholder at Baker, Donelson, Bearman, Caldwell, & Berkowitz, PC Discussion of 9/10 Department of Surgery MM&I conference Legal News Alert, Healthcare: PPACA Will Drive Quality Healthcare Reform Kaiser Family Foundation Tutorial on 2010 Healthcare Reform Week 4 (9/21) Humanizing Errors Provide students with an understanding of the complex nature of health care delivery Present to students a real example of error from affected loved ones Inform students of how response to error can develop new systems to prevent further harm and future errors Story by Mr. and Mrs. William H. Swiggart, MS, LPC/MHSP Co- Director, Center for Professional Health at Vanderbilt University Discussion by Neesha N. Choma, MD, MPH Associate Vice- Chair for Clinical Affairs, Director for Quality and Patient Safety, and Assistant Professor of Medicine in the Division of General Internal Medicine & Public Health at Vanderbilt University Medical Center None PS 105 Communicating with Patients after Adverse Events 5

6 Week 5 (9/28) Leadership & Teambuilding for Quality Improvement Learn how to create effective teams and engage and motivate care providers to focus on quality improvement HBR case study team case review, analysis, and discussion Lecture by Timothy Vogus, PhD Assistant Professor of Management at the Vanderbilt Owen Graduate School of Management HBR case study, Children s Hospital & Clinics PS 102 Human Factors & Safety PS 103 Teamwork & Communication L 101 So You Want to be a Leader in Healthcare? Week 6 (10/19) - Models for Quality Improvement Present a survey of common models for quality improvement including: root cause analysis, PDSA cycles, positive deviance, etc. Lecture by Carol Callaway- Lane, RN, MSN, ACNP- BC VA Quality Scholars Fellow and DNP Candidate at the Vanderbilt University School of Nursing AHRQ team case review, analysis, and discussion AHRQ Web M&M Cases Glucose Roller Coaster Techno Trip QI 102 The Model for Improvement Your Engine for Change PS 104 Root Cause and Systems Analysis 6

7 Week 7 (10/26) - Measurement of Quality Improvement Initiatives Present the challenges of measuring quality improvement initiatives and examine best practices for designing effective measurement systems Lecture by Jacob Hathaway, MD, MPH Staff Physician in the Primary Care Service at the Nashville VA Medical Center and Assistant Professor of General Internal Medicine and Public Health in the Department of Internal Medicine at Vanderbilt University Medical Center AHRQ team case review, analysis, and discussion AHRQ Web M&M Cases How Do Providers Recover from Error? - Low on the Totem Pole QI 103 Measuring for Improvement QI 106 Level 100 Tools Week 8 (11/2) - Designing Systems that Improve Safety Evaluate how operations science from the business world can be used within health care to improve processes and increase reliability/safety HBR case study team case review, analysis, and discussion Lecture by Michael A. Lapré, PhD E. Bronson Ingram Associate Professor in Operations Management at the Vanderbilt Owen Graduate School of Management HBR Case Study, Virginia Mason Medical Center 7

8 Week 9 (11/9) - ED Visit & Process Flow Exercise Practice mapping process flow in a delivery setting Assess process flow and make recommendations for improvement Facilitated by Stephan Russ, MD, MPH Assistant Professor of Emergency Medicine at Vanderbilt University Medical Center and Assistance Chief of Staff at Vanderbilt University Hospital Exercise at the Vanderbilt University Hospital and Monroe Carell Jr. Chidren s Hospital at Vanderbilt Emergency Departments Teams meet and make recommendations for improvement Week 10 (11/16) - The Continuous Learning Organization Evaluate the organizational conditions necessary to facilitate continuous learning and quality improvement Lecture by Rangaraj Ramanujam, PGDM, PhD Associate Professor of Management at the Vanderbilt Owen Graduate School of Management Discussion of 11/5 Department of Medicine MM&I conference QI 104 Making, Spreading & Sustaining Improvement: How the Work Gets Done QI 105 The Human Side of Quality Improvement 8

9 Week 11 (11/30) - Using IT to Improve Quality Demonstrate effective ways to improve quality/safety using information technology (IT), such as order sets, documentation templates, forced timeouts, etc. Lecture by Stuart T. Weinberg, MD Assistant Professor of Biomedical Informatics in the Department of Biomedical Information at Vanderbilt University Medical Center and Assistant Professor of Pediatrics in the Department of Pediatrics at Vanderbilt University Medical Center Discussion of 12/3 Department of Surgery MM&I conference Week 12 (12/7) Final Project Presentations Teams present final projects 9