Background

All health care providers seek to provide the highest quality health care to their patients.  Understanding the factors that determine the quality and safety of delivered health care and seeking to improve that quality should be a routine component of clinical practice.  Substantial experience now shows that a body of knowledge can be taught that will help enable health care providers to actively engage in improving health care quality and patient safety.  For residents and fellows, the ACGME incorporates quality improvement training into its Practice-Based Learning and Improvement (PBLI) and Systems-Based Practice (SBP) competencies.  As part of these competencies, the ACGME requires that trainees be taught quality improvement methods and participate in a quality improvement project.  These competencies seek to develop skills of practice analysis, ongoing learning, and continuous improvement, and to develop awareness of the larger context of health care delivery systems.  Specific language from the ACGME program requirements indicates that trainees should be able to “systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement”; and “work in interprofessional teams to enhance patient safety and improve patient care quality.”

Goals of Quality Improvement Module

The goals of the neonatology fellowship quality improvement module are to introduce fellows to key concepts in health care quality and patient safety through a series of didactic exercises, as well as active engagement in quality improvement activities and a quality improvement project.Specific goals and objectives for the module include:

• To understand broad concepts surrounding patient safety and quality improvement in health care
• To understand efforts to measure quality and safety in general health care and in neonatal intensive care
• To review approaches to medical errors and adverse events, including root-cause analysis
• To understand approaches to quality improvement
• To understand the importance of systems-based thinking in patient safety and quality improvement
• To engage in a project aimed at improving patient safety or health care quality

Components of Quality Improvement Module

The neonatology fellowship quality improvement module consists of four specific components:

• Two workshops
• Eight web-based educational modules from Institute for Healthcare Improvement
• A project focused on patient safety or quality improvement
• Optional selected readings and additional web-based modules

Additional fellowship activities that can support PBLI and SBP experiences include:

• Active participation of fellows in unit-based M&M conferences
• Periodic selection of QI or patient-safety focused literature for journal club
• Periodic presentation of QI or patient-safety topics in grand rounds or fellows conference