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Best Practices for Busy Clinicians: Applying Continuous
Quality Improvement in Practice

Developed by:	Peter Rudd, MD Professor of Medicine Chief, Division of General Internal Medicine Stanford University
Format:	Ten web-based, self-paced modules on continuous quality improvement (CQI) principles, techniques, examples, and templates coupled with two small group sessions. Each module includes specific learning objectives, summaries of major points and self-assessment quizzes.

How Will Clinicians Benefit?

This curriculum helps clinicians initiate, implement and expand local programs of "best practices" in their clinical settings. It teaches the skills needed to analyze clinical and systems problems and to institute change in clinical practice or clinic management. Clinicians learn to use CQI practices to enhance professionalism, promote accountability, and encourage improvements in care delivery.

Curriculum Description

The program includes ten self-paced, sequential modules; each module takes approximately 30 minutes to complete. All modules begin with a statement of learning objectives and end with a summary of key learning points and a self-assessment quiz. The topics include an introduction to CQI as a means of enhancing professionalism and improving patient care, specific techniques for analyzing and understanding variations in health care outcomes, and understanding and leading teams and organizations. Successive modules incorporate concepts introduced in earlier sessions and together the ten modules address the learning objectives described below. The materials include a glossary and links to text, templates, and web sites relevant to the discussion.

The entire program is designed for use in two phases and two formats (Web-based learning and small group discussion). In Phase 1, participants "register" online for the training, fill out the baseline assessment online, and complete the first five modules (~2.5 hours) over two weeks. At the end of two weeks, the participants meet in small groups (3-6 people per group) for a 1-2 hour discussion of the program content and its relevance to their clinical setting. The use of a facilitator trained in CQI techniques is useful, but not essential.

In Phase 2, the individual participants complete the remaining five modules (~2.5 hours) over two weeks. A post-test assesses change in knowledge since beginning the modules. At the end of the two weeks, the same small groups meet again for 1-2 hours to discuss the program content and to consider their willingness to serve as a project team to apply the lessons they have learned to their practice setting.

Learning Objectives

At the conclusion of these modules, participants will be able to:

1. describe continuous quality improvement and identify how it differs from usual practice or hypothesis-based research;
2. explain the reasons for variation in clinical care and the resulting opportunities for improving care;
3. define characteristics of effective CQI teams and describe ways to reduce common obstacles to their effectiveness;
4. apply useful tools for improving small group process;
5. apply tools for analyzing clinical processes of care;
6. describe the skills useful for managers and leaders of change;
7. identify the key steps and sequences in a CQI effort and determine how to problem-solve when results do not meet expectations;
8. describe the key concepts of statistical process control in the context of managing diabetes care;
9. identify approaches for reducing institutional obstacles to change and for preserving successful outcomes from CQI efforts.

Intended Audience

Physicians, residents, and nurse managers in medicine and family practice who are interested in improving the care they provide.

Pilot Testing

All ten modules have been tested on three groups including residents in Internal Medicine, general internists, and clinic managers and nursing unit supervisors. All participants provided descriptive information about their baseline knowledge and attitudes about CQI as well as their evaluation of the modules for clarity, relevance and personal impact. Participants also completed pre- and post-quizzes to assess changes in knowledge, attitudes, and confidence to undertake their own project to improve clinical practice.

Resources Needed to Use This Curriculum

• The program is designed for dissemination and implementation from a server-based web-site, either maintained at each site or accessible from a central source. For those programs unable to use such resources, the program will also be available on a CD-ROM for use at a single computer or locally over a local area network (LAN).
• Other needed resources include (a) computer access for each individual participant, (b) printers for hard copies of program resources (e.g., templates).
• An organizer to coordinate the small groups and to maintain a schedule for group meetings and/or a facilitator who can lead the small group meetings are optional resources.
  

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