nyu wagner spring 2018 - nyu wagner graduate school of ...2. ihi open school learning modules (5) --...
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NYU Wagner
Spring 2018
Faculty: Karen A. Scott, MD, MPH and Hillary Jalon, MSc
Meeting time: Wednesdays, 6:45- 8:25PM
Location: 194M 307, Washington Square
Faculty contact information:
The best way to reach us will be email: [email protected]; [email protected]
Email us both.
Please allow 24 hours for a response.
Office hours: by specific arrangement.
Continuous Quality Improvement (CQI)
HPAM-GP 2825 and GPH-GU 2425
Introduction
This course will provide students with an introduction to the tools and methods used to produce
effective changes in improving healthcare systems. We will explore the current policy and
practice environment driving the focus on value, quality and cost. We will discuss quality
broadly, as defined by the Institute of Medicine report – including attention to safety, patient
experience, and equity. Students will engage in how to initiate quality improvement (QI) work,
using proven methodologies, and how to take QI projects to the level of widespread, sustainable
change within a clinical practice, large healthcare provider, or healthcare system. We will study
how to develop strategies to engage key stakeholders, use measurement and data, and create
communications in order to achieve change.
Prerequisites:
CORE-GP.1011, Statistical Methods for Public, NonProfit, and Health Management
HPAM-GP.4833, Health Care Management 1: Control and Organizational Design
Computer proficiency
Students lacking the prerequisites must obtain permission to enroll in this course
Required for health management specialization students.
Learning Outcomes
At the successful completion of this course, students will be able to:
Appreciate the historical evolution of healthcare quality improvement
Apply a systematic method of improving a process using a team approach
Plan for the sustainability and spread of an improvement effort
This course also addresses Core Competencies recommended by the Commission on
Accreditation for Health Management Education (CAHME) which include:
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The ability to measure, monitor and improve safety, quality, access and system/care
delivery processes in health care organizations (Assignment #1: Article Review and
Assignment #3: Aim Statement and PDSA Worksheet)
The ability to use information systems and evidence-based management principles for
problem-solving, strategic planning and decision-making, and implementing and
measuring change. (Assignment #2: Use of Analytic Tool for Problem Analysis)
The ability to synthesize evidence, and apply statistical, financial, economic and cost
effectiveness tools/techniques in organizational analysis. (Assignment #4: Run and
Control Charts)
The ability to present convincingly to individuals and groups the evidence to support a
point of view, position or recommendation. (Assignment #5 Read and Review of Article
and Assignments #6a and 6b Spread Planner)
The ability to manage teams, projects and people; to work in change oriented health care
organizations; and mentor a diverse and changing workforce. (Final Project Team
Presentation)
**Expected level of competency to be achieved is denoted above as:
(1) Basic: Foundational understanding of knowledge/skill/competency
(2) Intermediate: Student demonstrates greater depth of understanding of this
knowledge/skill/competency and can use this ability to analyze a problem
(3) Advanced: student demonstrates expertise in this knowledge/skill/competency and
can use this ability to evaluate, judge, and synthesize information.
Learning Strategies
This course is based on:
1. Discussion of current events and the common themes emerging that are affecting the delivery
of healthcare services and
2. Learning by doing, i.e., applying methods learned in class to process improvement
assignments.
3. Process analysis provides the student the opportunity to think, read, write, and present ideas
logically in an organized manner. Emphasis will be placed on oral and written
communication and working in teams.
In this course, students will take the role of a team in a specific department or service in a
healthcare organization. Students will use management tools and techniques, diagnose problems
and develop innovative, practical and cost-effective solutions to address a process needing
improvement. Assignments are geared toward analyzing a specific process that is producing a less
than optimum outcome, identifying the data required to analyze the problem, and using specific
QI tools and techniques for innovative solutions. Finally, students will work on the additional
tasks required to make a solution sustainable, or spread across an organization.
Teams
Working in teams is a critical aspect of quality improvement work. Students will be grouped
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into teams of 4-5 members during the second/third sessions of this course, and work together
throughout the term on a process improvement project. Students will select an organization, to
which at least one team member has access, and investigate a process that needs improvement.
The process you choose should be meaningful to the organization so that recommended changes
can be adapted. You must be able to collect data (concurrently or retrospectively) about the
process over time, so be sure to choose a process that is well-defined and lends itself to
measurement.
IHI Open School
This course will integrate with the IHI Open School for Health Professions, an online school for
helping students learn about quality improvement and patient safety competencies. (See below)
Course Expectations
Attend every class on time,
Read all assigned materials prior to class,
Actively participate in-class discussions and exercises,
Actively engage and work with team members to complete assignments, and
Complete online and written assignments on time.
Please discuss with us as soon as possible should you foresee difficulty in adhering to any course
expectation. All class absences must be excused in advance. Extensions for assignment
completion are granted only in cases of emergency. Please contact us by email with either
of these circumstances.
Assignments and Grading
1. Written assignments (6) -- Total 48 points.
Assignments are to be handed in via email, before midnight of due date.
2. IHI Open school learning modules (5) -- total 25 points
completion online, evidenced by printed certificate.
IHI Open School course completed past the due date without approved extension will
not be credited.
3. Final Team Project and Presentation -- total 20 points
4. Class Participation and attendance -- total 7 points
A point will be deducted for unexcused absence
Late assignments will lose 2 points per day after due date.
Final project and presentation: students will work in small teams to develop and present a
specific improvement project, including the results of initial steps to test a change, data to
support improvement, and planning to take a project to a new location or team (spreading
improvement).
Wagner School Academic Code:
All students should review the Wagner School policies on academic honesty and grading by
visiting the NYU Wagner School web site at: https://wagner.nyu.edu
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Required Articles
Posted on NYU Classes
Required Online Courses
IHI Open School online courses are free to students and provide important lessons in patient
safety, quality improvement and leadership.
Completion of the selected courses (and due dates) as noted in the syllabus is required. To receive
credit for completion:
1. Generate the course completion certificate (you must complete the evaluation at the end of
the course to generate the certificate)
2. Submit the certificate through the NYU Classes site under “Assignment” as an attachment.
Written Assignments
There are two individual assignments and four team assignments.
Individual (10 points each)
#1. One page analysis and response: “What is Quality Improvement?” Based on the editorial by
Batalden and Davidoff, the recommended resources, and any other research as desired, please
write one page describing what you view or understand to be key features or components
necessary for effective quality improvement work. Explain how well these features are currently
integrated into healthcare systems, and at least 2 options for strengthening that integration.
#5. Case Review and Critique: Pronovost P, Needham D, Berenholtz S, Sipopoli D, Haitao C,
Cosgrove S, Sexton B, Hyzy R, Welsh R, Roth G, Bander J, Kepros J, Goeschel C.
An intervention to decrease catheter-related bloodstream infections in the ICU. New England
Journal of Medicine 2006, 355(26): 2725-2732.
Apply what you have learned from this course to date to a real case.
From what you have learned in the Continuous Quality Improvement course about using the
Model for Improvement to initiate and produce change, please read the article by Pronovost, et al,
and assess the strengths and weaknesses of the authors’ approach this issue. As you pull together
your analysis, please use the questions below as a guide: 1. Describe your thoughts about the interventions Pronovost and colleagues used in this endeavor.
What are the pros and cons of each part of the intervention that hospitals were asked to
implement?
2. What aspects of the team composition do you think were positive? What would you have changed
about the team composition, and why? What other disciplines might you have considered to
include?
3. What are your thoughts about the measurement strategy in this effort? Would you have included
process measures in the design? If you would have approached the measurement strategy
differently, please describe this here.
4. What do you think are some of the major strengths and successes of this work? What do you think
are some of the major limitations of this work?
5. Please describe any other thoughts you might have about this effort, and how you think this type
of endeavor has advanced the field of quality improvement and patient safety over the past 10
years.
Team (7 points each)
For each of the following assignments, please include a cover page stating your team name,
members, and “problem” to be improved.
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#2. Problem analysis: Select one analytic tool for analyzing your problem, prepare assessment of
problem using that tool, and explain why that tool selected.
#3. Model for Improvement: Complete Aim Statement and PDSA Worksheets.
#4. Run chart/control chart. Run charts are graphs of data taken over time. Control charts build
on run charts and are a key tool used to display variation in the process, and identify the presence
or absence of special or common cause variation. Gather data and prepare a run chart; add upper
and lower control limits to turn it into a control chart. Prepare a written statement of your
analysis.
#6 a and b. Spread planner. Complete the template provided to plan a process for spreading an
improvement from an initial project. The planner will guide you to consider the intervention,
communication plans, creating a social network for change, measurement and leadership.
Course content and schedule – posted on NYU Classes/Syllabus
1
Week Topic/Class
agenda
Required Reading/IHI Course Suggested reading/resources Assignments
Week 1
1/24/18
Introduction to
course
Quality
Improvement and
Healthcare Policy
Editorial:
“What is “quality improvement’ and how
can it transform healthcare?” Paul
Batalden and Frank Davidoff. Quality
and Safety in Healthcare 2007;16;2-3.
Article:
The Triple Aim: Care, Health, and Cost. Donald
M. Berwick, Thomas Nolan and John
Whittington. Health Affairs May 2008; Vol 27,
no 3:759-769.
2014 National Healthcare Quality & Disparities
Report. June 2015. Agency for Healthcare
Research and Quality, Rockville, MD. Retrieved
from:
http://www.ahrq.gov/research/findings/nhqrdr/nh
qdr14/index.html
www.whynotthebest.org
The Habits of an Improver. By Bill Lucas and
Hadjer Nacer. The Health Foundation. October
2015
Review instructions for
IHI Open School
course on NYU Classes
****INSTRUCTIONS
WILL BE POSTED
AS SOON AS
AVAILABLE,
PRIOR TO WEEK 2
(Individual)
Assignment #1
Article Review
One page “What is
Quality Improvement”
DUE 2/7/18
Week 2
1/31/18
How do we
improve?
Class organizes
into Teams; discuss
first Team activity
IHI Module QI 101: Introduction to
Healthcare Improvement
Chapter 1 in The Improvement Guide, G.
Langley, R. Moen, Kevin Nolan, et al.
2nd edition. 2009; pp 15-25
IOM 2001 Exec summary, Crossing the Quality
Chasm: A New Health System for the 21st
Century.
Retrieved from:
https://www.ncbi.nlm.nih.gov/books/NBK22227
1/
InInitial
2
Week Topic/Class
agenda
Required Reading/IHI Course Suggested reading/resources Assignments
Week 3
2/07/18
Understanding the
Problem: Analytic
Tools
Provost L, Bennett B. What's your
theory? Driver diagram serves as tool for
building and testing theories for
improvement. Quality Progress. 2015
Jul:36-43.
Fishbone (Ishikawa) Diagram:
www.asq.org
Pareto charts: www.asq.org
Failure Modes and Effects Analysis:
www.ihi.org
IHI Module PS 201: Root Cause,
System Analysis
The improvement Guide. G. Langley, R. Moen,
Kevin Nolan, et al. 2nd edition. 2009
Appendix B-Tools and Methods to Support
Improvement
Joint Commission Framework for Conducting a
Root Cause Analysis; link:
https://www.jointcommission.org/framework_for
_conducting_a_root_cause_analysis_and_action_
plan/
(Team) Assignment #2
Select one analytic tool
for analyzing your
problem. Prepare one
page assessment of
problem using that tool.
DUE 2/21/18
Week 4
2/14/18
Model for
Improvement:
PDSA Cycles
Chapters 4 and 5, pp 75- 108 in The
Improvement Guide
IHI QI 102: How to Improve with the
Model for Improvement
Week 5
2/21/18
Model for
improvement:
Measurement and
Data
IHI QI 103: Testing and Measuring
Changes with PDSA Cycles
(Team) Assignment #3
Complete Aim
Statement, and PDSA
Worksheet
DUE 3/7/18
Week 6
2/28/18
Using Data;
High Reliability
Organizations
The path to safe and reliable
healthcare. Leonard MW, Frankel A.
Patient Educ Couns. 2010;80:288-292
High Reliability. Sept. 2015
InInitial
3
Week Topic/Class
agenda
Required Reading/IHI Course Suggested reading/resources Assignments
www.Psnet.ahrq.gov
Week 7
3/7/18
Spreading
Improvements:
Community
Health
Improvement
Guest Lecture
“A Framework for Spread” Massoud
MR, Nielsen GA, Nolan K, Schall M,
Sevin C. IHI Innovation Series white
paper. www IHI.org
The Improvement Guide “Spreading
improvements” pp 210-216. Langley et
al 2009
Accelerating the Spread of Good
Practice. Section 8. Communicating to
make it happen, pp 65-78 Sarah W.
Fraser 2002
Spreading improvement across your health
system, editors Kevin Nolan and Marie Schall.
2006 Chapter 5 -“Redesigning Chronic illness
care in a public hospital system.”
Karen Scott Collins, MD, MPH and Reba
Williams, MD. Chapter 5 (pp 77-94)
Sodzi-Tettey S, Twum-Danso NAY, Mobisson-
Etuk LN, Macy LH, Roessner J, Barker PM.
Lessons Learned from Ghana’s Project Fives
Alive! A practical guide for designing and
executing large-scale improvement initiatives.
Cambridge, Massachusetts: Institute for
Healthcare Improvement; 2015. (Available at
www.ihi.org) pp 1-23.
(Team) Assignment #4
Complete Run Chart
and Control Chart
DUE 3/21/18
Week 8
3/14/18
SPRING BREAK
InInitial
4
Week Topic/Class Required Reading/IHI Course Suggested Reading/Resources Assignment
Week 9
3/21/18
Effective Teams and
Dynamics on
Interdisciplinary
Teams
Teaming, How organizations
learn, innovate and compete in
the knowledge economy. Chapter
3 – “The Power of Framing” pp
83-113. Amy C. Edmondson
(Individual)
Assignment #5
Read and review of
article:
Pronovost P,
Needham D,
Berenholtz S,
Sipopoli D, Haitao
C, Cosgrove S,
Sexton B, Hyzy R,
Welsh R, Roth G,
Bander J, Kepros J,
Goeschel C. An
intervention to
decrease catheter-
related bloodstream
infections in the
ICU. New England
Journal of Medicine
2006, 355(26):
2725-2732.
DUE 4/4/18
5
Week Topic/Class Required Reading/IHI Course Suggested Reading/Resources Assignment
Week 10
3/28/18
Using Improvement
Tools and Spreading
Improvements:
Guest Lecture
The Improvement Guide,
“Spreading Improvements” pp
195-205;
QI 201: Planning for Spread:
From Local Improvement to
System-Wide Change
Batalden, P. BMJ Quality and
Safety 2014; 23:4-7 “Making
improvement interventions happen-
the work before the work: four
leaders speak”
(Team) Assignment
#6a
Complete Sections
1-2 of Spread
planner
Completed Spread
Planner (Sections 1
through 5; Sections
3-5 will be given
during Week 12
class)
DUE 4/18/18
Week 11
4/4/18
HIT and Quality
Guest Speaker-
Meaningful Use Regulations and
Description:
https://www.healthit.gov/policy-
researchers-
implementers/meaningful-use-
regulations
6
Week Topic/Class Required Reading/IHI Course Suggested Reading/Resources Assignment
Week 12
4/11/18
Patient Centered
Care Linked with
Quality Improvement
Guest Lecture-
“Patient Centered Care: What
does it take?” Dale Shaller,
October 2007. The
Commonwealth Fund.
www.commonwealthfund.org
Presentation: “Sorting Fact from
Fiction: The Value of Patient
Experience Measurement.” Paul
Cleary, PHD, and Marc Elliot,
PhD October 2015.
www.Caphs.ahrq.gov
Issue Brief: “How Two Provider
Groups are using the CAHPS
Clinician and Group survey for
Quality Improvement” 2014.
“Patient Centered Care: What it
Means and How to Get There”
James Rickert. Health Affairs Blog.
January 24, 2012.
(Team) Assignment
#6b
Complete sections
3-5 of spread
planner
Submit completed
spread planner
(Sections 1 through
5) DUE 4/18/18
Final Project
Instructions Given
for Final Class
Team Presentation
DUE on 4/25/18
Week 13
4/18/18
Patient Safety
Guest Lecture-
Update on Safety Culture. A.
Frankel and M. Leonard. July-
Aug 2013 www.Psnet.ahrq.gov
Boysen PG. Just Culture/A
Foundation for Balanced
Accountability and Patient Safety
Ochsner J. 2013 Fall;13(3):400-
06.
AHRQ Hospital Survey on Patient
Safety Culture, web site link:
https://www.ahrq.gov/sops/quality-
patient-
safety/patientsafetyculture/index.html
Week 14
4/25/18
Class Team
Presentations
Groups 1 through 3
Submit Final Class
Team Presentation
4/25/18
Week 15
5/2/18
Class Team
Presentations Groups
4 and 5