Delving Deeper Into the Use of Education in Quality Improvement: A Profile of the 2023 Manning Grant Awardee Project
By Natalie Sanfratello, MPH, CHCP
During his keynote at this year’s Annual Meeting, David Price, MD, FAAFP, FACEHP, FSACME addressed the intersection between quality improvement (QI) and CPD/CE and how most of our industry is not adequately seizing the opportunity to align the two in the most effective manner. Now, our latest SACME Manning Grant Awardees will delve deeper into this issue and strive to provide guidance for those in CPD/CE offices and those working in quality.
The awardees, Joanne Goldman, PhD and Brian Wong, BSc, MD, FRCPC, work together in the Centre for Quality Improvement and Patient Safety (CQuIPS) at the University of Toronto. Joanne is an Education Scientist who has also spent time working in Continuing Professional Development and Brian is the Director of the Centre and a General Internist by training. Their proposal includes a scoping review of published QI initiatives which incorporate education as an intervention. Ultimately, they are aiming to synthesize how continuing education is being used in QI, to understand both gaps requiring attention and opportunities to build upon. Once they complete the scoping review, they will identify an international sample of authors to interview about their experiences incorporating education informed by evidence and theory from CPD/CE into their QI initiatives and the factors influencing these practices.
Speaking with Joanne and Brian about their research project, it was clear that they see opportunities where theory-based education along with addressing systems-based changes could improve clinician performance and patient outcomes. Informed by their extensive, collective experience as researchers, CPD/CE professionals, and Brian’s as a clinician, they believe there are multiple ways to strengthen collaborations across QI and CPD/CE. These could include quality professionals intentionally collaborating with CPD/CE professionals to not only strengthen the education provided as an intervention, but also more effectively evaluate the outcomes of that education, or CPD/CE professionals building the capacity within quality offices by teaching them continuing education theory and enabling them to conduct these initiatives independently. In either case, there are opportunities to work in concert for the betterment of patient outcomes.
“Our hope is that we will identify some really nice examples, rich examples, that we can draw from to develop some guiding principles around how others might go about doing this, and I suspect we will probably identify some gaps as well.”Brian Wong
Since education within the context of a QI initiative can often look like a didactic grand rounds session or a one-time lecture, some may think that education is an impermanent intervention when compared to systems-based changes. However, if the educational interventions incorporate evidence-based educational theory, it could lead to more efficacious interventions that will work to change the attitudes, beliefs, and knowledge of those learners which can then further permeate to others not directly participating in the education. For example, if a gap is based in institutional culture or beliefs, providing education that aims to affect that can benefit others who may join the institution after the education has taken place. If the institutional culture is not addressed, the systems-based change may fail. Furthermore, implementers can employ more novel approaches by utilizing different educational methods to impact performance change. Incorporating simulation- or reflection-based education and education that prioritizes feedback to the learners can reinforce the behavior changes sought. QI initiatives often incorporate multiple types of interventions addressing the myriad barriers and gaps that lead to suboptimal patient outcomes or clinician performance. As such, many initiatives could benefit from an intervention addressing gaps in knowledge and belief, and even more so, if that educational intervention utilizes evidence-based theory.
“I would say that education is extensively used in quality improvement initiatives… but there’s not necessarily the opportunity to engage with education at a deeper level in terms of the evidence and theory of CE or education more broadly in the context of QI interventions. Not enough attention has been invested in how do we either collaborate [with] or educate people who are working in the context of QI to engage with education in a more research-informed or theoretically-informed way when developing or implementing your interventions.”Joanne Goldman
Working in silos has only taken us so far, and we must now be intentional about cross-discipline collaboration among those interested in improving clinician performance and patient outcomes. Integrating quality improvement frameworks, CPD/CE theory, and robust data analysis can only help to move the needle forward in healthcare outcomes. Joanne and Brian hope to provide guidance to fellow CPD/CE professionals on how they may work towards better integration, and I, for one, am looking forward to seeing what they find and incorporating it into my own practice.
Natalie Sanfratello, MPH, CHCP, is Senior Program Manager for Quality Improvement, Educational Programs, and Contracts, QI Hub Faculty, Barry M. Manuel Center for Continuing Education, Boston University Chobanian & Avedisian School of Medicine.