Improving improvement.
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Delivery of Health Care↗
Biomedical subjects
Paul Batalden
Publications and source records attributed to Paul Batalden.
Exploring and embracing complexity in a distance-learning curriculum for physicians.
The recent pressures on clinical medicine such as the attention to medical error and the challenges of interdisciplinary care have also exerted pressure on health professions education. Educators must now gauge how to redesign education systems to adapt quickly to these disruptions. Sometimes disruptions can be self-inflicted, such as the VA National Quality Scholars Fellowship's decision to use interactive video (IV) as its primary medium for delivering the curriculum to its six sites around the nation. The authors describe how this disruption to their education system helped to fashion a learning environment that is adaptable. Along the journey from a classroom-based curriculum to an IV-based curriculum, the authors and others involved in the program learned the basic tenets of IV sessions, redefined the roles of the teachers and learners, and discovered an IV environment that functions as a complex adaptive learning system. This distance-learning curriculum can be a model for other health professions education, since it starts with simple rules, changes from within, has a tolerance for unpredictability, and continually moves forward and transforms itself despite tension.
Curriculum↗
What will it take to lead the continual improvement and innovation of health care in the twenty-first century?
We have witnessed the separation of the care for an individual patient and the concern for the health of a population. As we anticipate the twenty-first century, we see the wisdom of reconnecting these concerns. The knowledge and skills that we will address can help bridge the gap. First, we offer background to seminal work during the twentieth century that set the foundation for the improvement of health care. Next, we describe two major challenges for the continual improvement of health care that lie ahead. Third, we suggest an approach that leaders might use to address major challenges. Fourth, we offer a set of knowledge domains that outline the knowledge and skills that leaders of the improvement of health care will need. Finally, we provide two special issues that require additional mention and should not be overlooked. We believe that the combination of these ideas can provide a framework for knowledge building, action taking, and reflection needed by health care leaders in the coming century.
Delivery of Health Care↗
Good measurement for good improvement work.
PURPOSE: To provide guidance on using measurement to support the conduct of local quality improvement projects that will strengthen the evaluation of results and increase their potential for publication. TARGET GROUP: Individuals leading quality improvement efforts who wish to enhance their use of measurement. PROCEDURES TO PROMOTE GOOD MEASUREMENT: Eleven procedures are offered to promote intelligent measurement in quality improvement research that may become publishable: 1. Start with an important topic 2. Develop a clear aim statement 3. Turn the aim statement into key questions 4. Develop a theory about causes and effects, process changes and predictable sources of variation 5. Construct a research design and accompanying dummy data displays to answer your primary research questions 6. Develop and use operational definitions for each variable needed to make your dummy data displays 7. Design a data collection plan to gather information on each variable that will enable you to generate reliable, valid, and sensitive measures related to each research question 8. Pilot test the data collection plan, construct preliminary data displays, and revise your methods based on what you learn 9. Stay close to the data collection process as the data plan goes from idea to execution 10. Perform data analysis and display results in a way that answers your key questions. 11. Review and document the strengths and limitations of your measurement work and use this knowledge to guide intelligent interpretation of the observed results.
Health Facilities↗
General competencies and accreditation in graduate medical education.
Many have recommended changing the professional development of physicians. Concluding that further educational process specification was inadequate, the Accreditation Council for Graduate Medical Education (ACGME) decided to specify six general competencies of graduate medical education (GME): patient care; medical knowledge; practice-based learning and improvement; professionalism; interpersonal skills and communication; and systems-based practice. Coupling them with a developmental view of professional knowledge and skill acquisition, the ACGME invited further specification and development of desired learning from the extended medical specialty community, including the specialty boards. This collaborative process offers a model of the role accrediting agencies can play in fostering workforce developmental change.
Accreditation↗