Column Editor: Natalie Sanfratello, MPH, CHCP
NEW! The aim of this column is to Identify resources available for training in QI concepts and identify strengths within the CE/CPD office for facilitating QI work.
QI-CPD Resources Everyone Should Use
By Natalie Sanfratello, MPH, CHCP
The Centers for Medicare and Medicaid Services (CMS) defines Quality Improvement (QI) as “…the framework used to systematically improve care. Quality Improvement seeks to standardize processes and structure to reduce variation, achieve predictable results, and improve outcomes for patients, healthcare systems, and organizations.” 
Engaging in QI initiatives with practicing clinicians may feel daunting for CE/CPD professionals who do not have existing programs. However, we (in CE/CPD) can make meaningful contributions to these activities, and this article will provide some examples of professional development opportunities to grow your expertise in QI. In addition, I will list, from my experience, what we have offered to quality departments and clinicians engaging in QI projects.
Professional Development Opportunities
These resources will help to build your fund of knowledge in QI:
- Institutional offerings: Your institution may hold group memberships to existing QI education or offer training that is affordable or free. Some examples of these may be an Institute for Healthcare Improvement (IHI) Open School membership or institutional training on Lean Six Sigma. At my institution, we have a membership to the IHI Open School which I found very helpful in building foundational knowledge, gaining access to existing tools and resources, and learning the vocabulary necessary to collaborate with others in the QI space. It is important to find out which QI model is employed within your institution’s clinical setting, so that you can be sure to adopt the same mindset and terminology.
- Free Online Resources: The IHI also has some free resources you can access without an open school membership. Through a cursory google search, I was able to find other free resources from The Agency for Healthcare Research and Quality (AHRQ), the Public Health Foundation (PHF), and the Saskatchewan Health Quality Council, among others. If your institution is unable to support paid professional development in this area, then these may be your best bet!
- Books: I have found three books to be most helpful on my quality improvement journey (although I am sure there are others out there!). These are: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance, The Health Care Data Guide: Learning from Data for Improvement, and SACME’s own Continuing Professional Development in Medicine and Health Care. These books are more affordable than many of the paid courses available, and your institution may have copies of them.
Now that you have built up your foundational knowledge in the framework that your institution prefers, where will you go from here? When justifying to leadership why it makes sense for a CE/CPD professional to be involved in quality improvement projects, there are a few main categories that may help highlight the value of QI and promote/advance the institution’s efforts to align their QI initiatives. These include:
- Accreditation/MOC: Providing PI and MOC credit can be a great way to get your foot in the door with QI projects already happening in your institution (or a partnering health center). These activities often offer a large number of credits and satisfy maintenance of certification requirements, so this is an important carrot for busy clinicians. Gaining access to the information about existing projects in the institution can be an invaluable opportunity to gain a lay of the land and begin to brainstorm how you can expand your involvement into the buckets below.
- Project Management Support: In my experience, I have seen that one of the main challenges clinicians face in completing QI initiatives is a lack of project management leading to a loss of momentum. Clinicians often work on these QI initiatives informally, in addition to their clinical obligations, and without dedicated time to do so. As such, competing priorities can pull them away and, even if just momentarily, momentum can wane, and a project can fizzle out. CE/CPD offices can provide project management support to the QI initiatives and help with the logistics of pulling team members together, scheduling meetings, reaching out to stakeholders, requesting resources or IT tickets, and managing timelines. CE/CPD professionals are expert project managers, and this type of help will likely be welcomed by clinical leadership especially if there are quality gaps to be addressed.
- QI Consultation/Expertise: Although the professional development opportunities I listed above will provide you with a helpful foundation of QI knowledge, the best way to gain expertise, like most other things, is to see it in action and participate in the projects. If you have had the opportunity to provide credits and/or project management support, you will likely have gained some helpful tricks of the trade and insight into what QI projects are like in real practice. In that case, you can provide QI consultation and expertise through ad hoc meetings with those interested in mentorship or even through the accreditation process itself. Since you will need to make sure a program meets the requirements for the PI or MOC credit, you can take the opportunity to ensure those needs are met and provide additional recommendations for a more robust or sustainable project.
- Funding/Grants: Finally, some CE/CPD offices already have experience with proposal development and grant management and can provide that expertise to apply for funding from sources such as commercial support, government funding, or institutional funding for projects that have (or would benefit from) a focus on QI. This would be a good opportunity to build in project management funding for the CE/CPD office as well as dedicated time via salary support for the clinicians working on the project. While QI is happening with or without the additional funding, support can make a difference in the robust nature of the interventions, performance monitoring, and sustainability of improvements.
Quality improvement is an important key to creating sustainable change in patient and population level outcomes. QI addresses systems-based issues to overcome barriers to care and ultimately improve patient health. QI allows for interprofessional collaboration and the feeling of agency that one can enact real changes to improve the environment in which they work. CE/CPD offices should feel empowered to learn more about QI and leverage the existing expertise they have to become more involved in addressing quality gaps within the institution. Good luck out there!
 Centers for Medicare and Medicaid Services (CMS). Quality Measurement and Quality Improvement. 2021. Available at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/MMS/Quality-Measure-and-Quality-Improvement-#:~:text=Quality%20improvement%20is%20the%20framework,%2C%20healthcare%20systems%2C%20and%20organizations. Accessed May 23, 2023
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.