A Massive Open Online Course (MOOC): The Science of Safety in Healthcare, Builds Capacity and Improves Competence for Patient Safety among Global Learners

Background: Almost everyone will be a patient at some point in their lives.  Estimates suggest that over 98,000 patients die in US hospitals each year due to medical errors; making medical errors a leading cause of death.  Adverse events in healthcare often result from problems in the complex systems of care.  Improving patient safety demands a complex system-wide effort, involving a wide range of actions in performance improvement, environmental safety and risk management.  Healthcare professionals and consumers must partner in these efforts.

Massive open online courses (MOOCs) allow for affordable, lifelong learning and professional development using an accessible platform.  Course delivery is asynchronous which means that leaners can participate from anywhere at a time that is convenience to them.  From an educator’s perspective, MOOCS offer a unique opportunity to reach a large, diverse local to global audience.  The purpose of this paper is to describe a MOOC, The Science of Safety in Healthcare, which was delivered twice, in 2013 and 2014, and its’ effect on participants’ Competence in Patient Safety.

Course Description: The 5-week course was designed to address the foundational principles of the science and culture of safety in healthcare.  The course was organized in 5 modules as follows:

• Module 1: An overview of the science of safety and an introduction to a culture of safety in healthcare.
• Module 2: Enabling and contextual factors, including communication, teamwork, and healthcare human factors, that influence patient safety and quality were explored in this module.  This module also included patient-centered care and strategies for patients and families to contribute to patient safety.
• Module 3: Methods to improve safety and quality: Given the system complexity and various sources of healthcare safety and quality defects, multiple methodologies including sound measurement approaches are required to improve safety and quality.  In this module, several examples of available methodologies to improve safety as well as measurement strategies were examined.
• Module 4: Translating evidence into practice and leading change: In this module, learners explored the TRiP Model for translating evidence into practice, reviewed an integrated approach to improving the reliability of care, and distinguished the technical and adaptive challenges of safety and quality improvement.
• Module 5: Summary and opportunities for capacity building: In this final module, the course was summarized and key concepts reinforced.  In addition, further opportunities to build capacity in patient safety and quality improvement were presented.

Each module was divided into multiple video segments that could be grouped as three or four lectures or viewed separately.  The platform permitted flexible, self-paced learning.  Participants were introduced to the key concepts, tools and skills required to promote patient safety and reduce preventable harm.  Simulations were created to allow participants opportunities to apply patient safety concepts and improvement tools to realistic, engaging scenarios.  Structured exercises challenged participants to consider patient safety concepts, principles, and best practices.  Weekly discussion board forums fostered small group communication on specific topics generated by participants and interaction with course faculty.  In fact, course participants capitalized on a common social media venue, Facebook, and created a page dedicated to this course and networked during and after course completion.

The course was designed to target the needs of health professionals, students, and health consumers interested in learning about patient safety.  The participants had a broad range of experience in healthcare, ranging from consumers of healthcare with no prior training in healthcare to licensed clinicians with experience in leading patient safety efforts.  In 2013, 20,957 participants enrolled in the course and 1,229 (5.9%) of those participants earned a certificate of completion. In 2014, 9,679 students enrolled in the course and 674 (7.0%) of those participants earned a certificate of completion. Over the two course offerings, the majority of participants (57%) were 25-44 years old and female (54%).  The countries with the top 3 highest proportions represented were the United States (38%), India (5%) and Canada (5%).  The majority were health professionals (61%) or health professionals in training (7%). 

Evaluation methods: Participants were evaluated post-course using the Health Professional Education in Patient Safety Survey (H-PEPSS), which focuses on culture, teamwork, communication, managing risk, and understanding human factors to measure patient safety competence.  Pre- and post- course H-PEPSS scores were compared using paired T-tests.  Additionally, post-program surveys were conducted at the completion of the course and 6 months following completion to measure participant satisfaction and applications of knowledge and skills developed through the course.

 

Course Evaluation and Impact:  Participants’ mean scores on the H-PEPSS scales improved from baseline to the completion of the program in the 2013 and 2014 courses.  Participants who completed the H-PEPSS surveys from 2013 (n=913) and 2014 (n=406) demonstrated significant increases across all of the subscales both years (p<0.001).  The 6-month survey from the 2013 course showed high levels of satisfaction.  Participants who completed the surveys (n=486) reported that they strongly agreed the content learned in the course was useful (68%) and agreed or strongly agreed that the course positively influenced their clinical practice (71%).  Examples of participant feedback in the 6-month post survey included: “As an attorney specializing in medical staff issues, it is very useful to look at issues from a systems perspective, rather than an individual physician responsibility perspective.” “In working on large-scale implementation, the course broadened my knowledge base of quality improvement change and how to approach clinicians and evaluate clinical situations to help institute change and quality improvement implementation strategies.” “The focus on practical ways to measure and address organizational culture has been very useful for my work.”  The majority (71%) of participants indicated that they participated in, or are planning to participate in, additional educational activities to learn about patient safety.  The 6-month post survey for the 2014 course has just been deployed and results are pending.

 

Conclusion: The MOOC course platform allowed educators to reach a very large, diverse audience, though rates of full participation and completion were low.  The course was well-received and among those who submitted pre- and post-course evaluations, a significant increase in competence in patient safety improvement was reported.