“Quality over quantity.” It’s familiar advice for everything from shopping habits to food choices. But the concept is particularly important when it comes to health care. In fact, this is what led a coalition of entities from the CU Anschutz medical campus – the Medicine Schoolthe College of Nursing, University of Colorado Hospital UCHealthand Colorado Children’s Hospital — to establish the Institute for Quality, Safety and Efficiency in Health Care in 2012.
“We have seen that the world is changing and that health care is moving from a focus on the volume of care to the value of care, and from the quantity of care to the quality of care”, explains the director of the IHQSE Jeffrey Glasheen, MD, MHMAssociate Dean for Clinical Affairs – Quality and Safety Education and Professor of Medication.
“While we fully endorsed this change, we recognized that we did not have a trained frontline workforce to make this change,” Glasheen continues. “Thus, the IHQSE was born.”
IHQSE’s mission is to improve the quality, safety, and efficiency of patient care at the CU Anschutz Medical Campus by educating providers and helping them implement change within their teams, departments and organizations.
“This type of change can’t come from the top of organizations,” says Glasheen. “It has to come from the front lines – doctors, NPs, PAs, nurses, pharmacists, etc. – because they are the people who interact with our patients and our processes.
The focus on implementation sets the IHQSE apart
The IHQSE currently offers four different programs:
Quality Safety Academya series of six three-hour workshops designed to build foundational knowledge about quality improvement and patient safety.
A year Certificate Training Program emphasizing the development and improvement of high performing teams capable of systematically improving the quality, safety, cost and experience of patient care. Includes 15 to 20 hours of intensive and practical coaching.
Facilitating Leadership is a two-day course that provides participants with a transformational learning experience that expands their ability to lead lasting change, generate greater engagement, and bring out the best in individuals and teams while achieving exceptional results.
Improvement Academy is a two-session course followed by up to 12 months of coaching sessions aimed at providing participants with the fundamentals of quality improvement and how to structure and lead improvement projects.
Although other organizations are already doing similar work, Glasheen says IHQSE’s unique approach to the topic sets it apart.
“We were one of the first organizations to recognize that this was not a problem of lack of knowledge,” says Glasheen. “The concepts of process improvement and change management are relatively simple, and healthcare providers are incredibly smart people. Where it gets tricky is when you try to take these concepts and apply them in the clinical realm.
The IHQSE resolves this disconnect through a combination of education, application, and implementation.
“That’s what sets us apart from a lot of other programs,” says Glasheen. “When we teach something in the classroom, it’s not supposed to stay in the classroom. We bring it back the following week in a coaching session and immediately start applying it to their work.
Since the first CTP cohort in 2013, IHQSE has trained more than 2,300 healthcare leaders and providers, as well as medical students and interns. And, notes Glasheen, what is taught in the classroom does not stay in the classroom. Many IHQSE programs encourage or require trainees to develop and implement projects in their clinical practices that lead to real-world improvements.
Projects improve patient care
One such project aimed to reduce exposure to sedatives such as opiates and benzodiazepines in mechanically ventilated pediatric intensive care patients.
“We had been working on this project since 2015 and previously struggled to figure out how to accurately assess our patients’ exposure to these drugs,” says Gina DeMasellis, MDassistant professor of pediatrics who followed the CTP training with four of his colleagues in 2020.
“The old process required manual chart reviews to add up each exposure. It was just too much work,” DeMasellis says.
During the course, she and her colleagues finalized a dashboard to automatically tally and display drug exposures. Then they focused on creating a plan to help PICU nurses comply with instructions to gradually wean patients off the drugs when they were no longer needed, which they accomplished through surveys and mentoring.
Since implementing the plan, DeMasellis and his team have reduced the exposure to opioid medications of their pediatric patients in mechanically ventilated intensive care units by approximately 20%.
“The mentorship we received during the course was absolutely phenomenal,” says DeMasellis. “Personally, I believe that anyone working in a clinical area should be thinking about quality improvement — there’s so much work to do that it can’t be left to a select few.
Sarah Parker, MDProfessor of Pediatrics and Medical Director of Antimicrobial Stewardship Program at Children’s Hospital Colorado, is another CTP graduate. When she was hired in 2011 to start the stewardship program, her main goal was to improve the use of antibiotics in hospitalized patients.
“Studies have shown that 30-60% of antibiotic use is probably unnecessary,” Parker says, explaining that over-prescribing or prescribing the wrong antibiotics can lead to adverse drug events and bacterial resistance. . “You want to make sure patients are getting the right antibiotic for the right indication at the right dose for the right duration.”
Parker and his colleagues enrolled in CTP to design a program based on building relationships with hospital management and clinical providers.
“The course changed everything for us,” Parker said. “It helped us understand the best ways to approach leadership to get the resources we needed and how to get provider buy-in from the prescriber side through what’s called ‘handful of stewardship. main’. And we have achieved many of our goals. We have demonstrated a significant decrease in antibiotic use and shown that the remaining use has improved, which in turn has improved patient care.
Members of a team from the certification training program present their project.
Transformation at all levels
Over the past 10 years, IHQSE interns have completed more than 500 projects that the institute claims have impacted more than 100,000 patients and saved more than $100 million by reducing inefficiencies.
Glasheen also says that the IHQSE is the first program in the country to publish the results showing that investing in quality, safety and efficiency can impact the performance of the entire organization. Since interns began completing improvement projects at UCH, the hospital has increased the star rating of its Centers for Medicare and Medicaid Services from two to four (out of five).
“Obviously there were other factors involved in this change as well,” says Glasheen, “but I think the IHQSE provided the special sauce, which was people’s ability to do the job.
“It’s not just about education – it’s about transformation,” adds Glasheen. “We want to transform people who can then transform processes to improve care. If you do this hundreds of times, you will eventually transform your entire organization. »
A new decade
As IHQSE enters its next 10 years, Glasheen says the institute’s leadership intends to expand its offerings, both on and off campus.
Last year, the IHQSE absorbed the Clinical Effectiveness and Patient Safety Grant Program, which provides funding and mentorship to faculty, trainees, and staff to support their efforts to advance the quality and safety of care at UCH and Colorado Children’s Hospital. Glasheen says housing the program as part of the IHQSE will allow the institute to cross-train providers and potentially build an even stronger grants program.
The CU School of Medicine recently moved some of its graduate medical education in quality, safety and effectiveness under the IHQSE, which Glasheen hopes eventually to extend to undergraduate medical students as well, providing a cohesive and unified curriculum at all levels. .
The IHQSE also began to radiate beyond the borders of the medical campus of CU Anschutz. The institute now offers three of its programs to a national audience: a virtual version of CTP, which will launch in April 2022; Foundations in Healthcare Leadership, a three-and-a-half-day in-person program launching in March; and a national version of the Quality Safety Academy.
While there’s a lot going on within the IHQSE, when asked what excites him most about the future, Glasheen’s answer is simple.
“I love educating people and watching them grow – that’s the best part.”