An Interprofessional Patient Safety Fellowship Improves Systems Thinking and Quality Improvement Knowledge among Health Professionals: Building Local Capacity for Patient Safety

Background: The Institute of Medicine report, Health Professions Education: A Bridge to Quality, recommended training to give health professionals the skills for safe, high-quality, and patient-centered care.  However, incorporation of this training has been limited.  When training is provided, program evaluation is often not reported. To build local capacity for patient safety and quality improvement (QI) work we have been training health professionals in our system.  Health professionals identified that they were eager to contribute to patient safety work and had key insights regarding strategies for improvement but often lacked the knowledge, skills, and experience in patient safety and QI methodologies.  Additionally, patient safety leadership roles have been introduced on many patient care units and unit-leaders and staff voiced a need to build capacity for those moving into these positions. 

Patient Safety Fellowship: The Armstrong Institute (AI) Patient Safety Fellowship was developed and implemented at Johns Hopkins Medicine, a large tertiary healthcare center which includes 3 academic medical centers, 3 community hospitals, a large ambulatory clinical practice (35 sites), and a home care company.  Health professionals, interested in enhancing patient safety and QI leadership skills, throughout the institution were eligible to participate.  All health professionals working at Johns Hopkins Medicine institutions, and receiving approval from their supervisor, were eligible to apply to the Fellowship.  Departmental emails were sent to unit leaders and staff to solicit applications.  Selection was based on prior QI experience, interest in pursuing a quality and patient safety career, and selection committee consensus.

This six-month program was developed by AI experts in curriculum development, patient safety and QI methodology, implementation science, and program evaluation.  The program was intended to build knowledge and skills in patient safety and QI leadership and systems thinking among participating staff.

We implemented the Fellowship for health professionals (n=5 in first cohort, January - June 2013; n=17 in second cohort, January –June 2014) with a highly structured curriculum.  Participants were health professionals, including nurses, physicians, and administrators, interested in leading patient safety initiatives at our institution.  The curriculum included the following components:  1) a mentored patient safety or QI project, 2) practicum experience with Johns Hopkins quality and safety group experts, including participation in an institution-wide patient safety or QI committees, and 3) participation in didactic educational lectures and experiences.  Participants in the Fellowship met as a cohort weekly for 6 months and received salary support of 8-12 hours per week to “back-fill” their clinical obligations.

Program Evaluation: Program evaluation included the Quality Improvement Knowledge Assessment Tools (QIKAT) and Systems Thinking Scale (STS) both prior to and immediately after their experience in the curriculum. Median QIKAT scores (Pre: 27 vs. Post: 41; p=0.042) and median STS scores (Pre: 56 vs. Post: 71; p=0.042) significantly increased through participation in the AI Patient Safety Fellowship Program indicating higher reported competency on both scales.  In addition, participants provided qualitative feedback on the program experience.  One participant provided the following feedback: “The opportunity for mentorship and education from AI safety and quality experts has been invaluable to my career ... developing "lenses" to identify defects  … learning a structured framework to tackle these defects and navigate within a project … is a skill set I will continue to utilize moving forward ... into my day to day practice.”

We identified the need to provide additional support to fellows in the development of project metrics and analysis plans and the curriculum was modified accordingly for the second cohort.   Additionally, we have developed a Patient Safety Certificate Course, which is now a requirement for program participants.  The majority of program participants have continued their involvement in initiatives to improve patient safety and quality at our institution.  Feedback from participants and unit leaders supported continuation of the program. 

Conclusion:  This structured patient safety fellowship program is an effective strategy for improving quality improvement knowledge and systems thinking building capacity for patient safety and QI improvement among health professionals.  With a high level of institutional support, we have expanded the program to include 33 participating health professionals in our current cohort.  We are collaborating with institutional leaders to ensure the sustainability of this program.