Students as Change AgentsFacilitators & Barriers to Improving Care
with Clinical Teams
5/18/2017
Peter DaveyLead for Healthcare Improvement
Scottish Improvement Science Collaborating Centre
Vicki TullyLead for Patient Safety
Emma Burnett
Nicola Gray
Jenna Breckenridge
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Agenda
• Who are you?
– What is your role in teaching & learning?
• Learning outcomes for students from QI projects
• Improvement projects in Dundee MBChB and FY
• Group work on barriers & facilitators
• Review of results from 4th NSMEC in 2014
• SISCC evaluation
• Next steps: Dundee MBChB & ScotGEM
• Discussion
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Who are you?
• What is your involvement with teaching medical students?
– Do you teach Dundee students?
• What is your involvement with FY training?
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4th NSMEC 2014 Workshop Results
Top 3 learning outcomes for students from QI projects:
1. Understanding of methodology (what is QI, PDSA?) as a transferable skill
2. Showing that QI works, effective communication to bring about change, sustainability
3. Context and environment of healthcare ("what pisses you off most"), systems thinking
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• Preparation prior to starting FY shadowing
• Meet other FY's in your ward team
• FY Safety Checklist used to consider the way you will work on your own, within the team, the tools and technology you need to be familiar with and the ward environment you will be working in.
• Handover of Care Workshop
FY Induction
August
•FY Teaching Programme - 'Improving Safety for Patients and FY's'
•Session with Associate Medical Director and Associate Director for Patient Safety
•Over a three month period FY's complete training on Datix system, report an incident they have witnessed or been involved in and reflect on the incident using MERIT tool.
•Feedback is given to FY's to be used as a Case Discussion to meet Portfolio Quality and safety Outcomes.
•Data on types of incidents reported is themed and shared with Deanery, Directoriate of Medical Education and Associate Medical Directors Group.
FY Incident Reporting
December - March
•FY Teaching Programme - 'Getting it Right for every Patient every time'
•Follow up on feedback from December session - 'You said - we did'
•SQSP fellows deliver session re. deteriorating patients, medicines safety and MDT communication
Getting it Right for Every Patient every time
May
Foundation Year 1 Safety and Quality Programme
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•FY2 teaching programme 'How to get your QI project started'
•Use IHI QI modules to support learning
•Use IHI Practicum and handbook
•FY2 allocated a QI mentor to support face to face QI coaching
Quality Improvement 'How to get your project started'
August
•FY 2 teaching programme 'Understanding the system'
•QI mentor support with project
•Continue to use IHI Practicum and handbook
Understanding the System
December
•FY2 teaching programme 'Sharing the learning from your QI work'
•QI mentor support with project
•Getting ready to submit QI work for IHI Practicum certificate
Sharing the Learning
June
Foundation Year 2 Safety and Quality Programme
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What we would like you to do
Identify the top three issues for each aspect of student/FY’s QI projects
1. What are the facilitators to students/FY’s participating in QI projects?
2. What are the barriers to students/FY’s participating in QI projects?
Students as Change AgentsSISCC Evaluation
April 2016 Year 5 SSC on Patient Safety
• Eight students with different clinical teams1. Improving the management and satisfaction of medical boarded
patients in ENT wards2. VTE prophylaxis wit TED stockings in a surgical ward: 3. VTE prophylaxis with anticoagulants in a medical ward
May 2016 Year 2&3 SSC on Improving Care with Clinical Teams
• Eight students in Anaesthetics1. Improving the theatre sign in2. Improving the monitoring of endotracheal and laryngeal cuff pressures3. Improving the emergency theatre safety brief
Students as Change Agents: Conclusions
• Students need meaningful, workplace based service-learning with clinical teams from Year 1Service-Learning“A method under which students learn and develop through active participation in thoughtfully organised service experiences that meet actual community needs, that are integrated in the students’ academic curriculum or provide structured time for reflection and that enhance what is taught in school by extending student learning beyond the classroom and into the community.”Corporation for National and Community Service 1990
• Goals identified by clinical teams are less likely to lead to challenges with competing priorities and engagement
• Students need to be involved with problem finding and defining goals as well as prototyping
Process mappin
g
From Projects to
Sustained
Improvement
Habits of an ImproverPatient shadowing
Patient experience interviews
Practice development,
feedback to teams
Service design
Practicum
Practicum
Lucas & Nacer 2015 The Health Foundation http://www.health.org.uk/publication/habits-improver
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InformationPatient experiencePatient shadowingStoriesTouch points
InsightsEmpathyNeeds, ValuesPriorities
IdeasTeam workingDrivers for changeFeedbackAction planning
TestingPDSA cyclesMeasuresUnanticipated consequences
Iterative Processes
Solutions
Goals
Double Diamond Design ProcessProblem Finding Prototyping
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Dundee MBChB five year plan
• Healthcare improvement (patient safety, human factors & person centred care) is integrated and visible in all years
• All students will participate in workplace based service-learning about person centred care from years 1-5
o Patient shadowing
o Patient experience interviews
o Practice development
o Service design
• All students have the opportunity to apply quality improvement methods to at least one area of practice with a clinical team over the 5 years
Proposed March 2016
Awarded June 2016
40 Places
‘Bonded’ to NHS + Bursary
2018 start
Any degree 2i or 1st.
ScotGEM in essence
Defining Features
• Clearly distinctiveGeneralist focused training
Community based - (By choice-not by chance)
Remote and rural components
Improve healthcare across Scotland – ‘underserved communities’Service Learning
Healthcare Improvement
• Stimulate innovation in medical education
• Case Based Learning
• Create capacity in non-teaching health boards
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Questions?
