Epilogue: Reflections from International Mentors of the Quality Improvement Training Programme in India

Abstract Aims Quality improvement (QI) training in Junior Doctors (JDs) is essential for providing High Quality Care for patients and facilitating organisational success. The aim of this study was to systematically review the evidence on QI training in JDs and determine the impact and effectiveness of training methods. Methods A systematic review was conducted as per PRISMA guidelines. Searches were carried out using MEDLINE, EMBASE and HMIC for English-Language articles between January 2005 to December 2019. Selected articles underwent critical appraisal using the CASP criteria by two independent reviewers. A qualitative and thematic analysis was conducted. Results 43 studies were identified in a range of medical and surgical specialities. Common QI methodology included theoretical and project-based curricula with content focussing on PDSA cycles, root causes analyses and project development. Majority of studies reported improved knowledge, leadership skills and satisfaction. Mentorship and coaching were highly valued, but few studies adhered to this practice. Few studies demonstrated increased QI engagement. Key themes identified (i) Effectiveness of QI training (ii) Barriers to engagement (iii) Organizational culture of fostering QI. Conclusion There is growing mandate for training JDs in QI practices to enhance patient care. QI curricula targeting JDs have demonstrated improved knowledge and leadership skills. Nonetheless, significant barriers in QI engagement endure. Additional research is required to combat disengagement and assess sustainability of QI interventions in JDs. We further aim to introduce a pilot QI training programme for surgical JDs to enhance leadership skills.

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Development of the conceptual framework for a quality improvement training programme for health professionals in the ministry of health and social services in Namibia

International Journal of Health ◽

10.14419/ijh.v4i1.6109 ◽

2016 ◽

Vol 4 (1) ◽

pp. 46

Author(s):

Julia Paul Nangombe ◽

Hans Justus Amukugo

Keyword(s):

Quality Improvement ◽

Conceptual Framework ◽

Social Services ◽

Health Professionals ◽

Care Delivery ◽

Training Programme ◽

Health Facilities ◽

Ministry Of Health ◽

Quality Health Care ◽

Health And Social Services

This article describe the process followed by the researcher in the development of the conceptual framework for a quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia. The conceptual framework of this study was based on the Practice Orientated Theory of Dickoff (1968) that assisted with explaining the concepts used in developing the quality improvement training programme for health professionals at the health facilities. Dickoff’ s (1968) practice orientated theory consists of the agent, recipients, context, procedure, dynamics, and the terminus. In this study, the agent was a quality specialist, the recipients were health professionals, the context was the health facilities, the dynamics were challenges that health professionals were experiencing; the procedure was the training programme, while the terminus was knowledgeable and skillful health professionals in quality health care delivery.

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Immediate and long-term effects of a team-based quality improvement training programme

BMJ Quality & Safety ◽

10.1136/bmjqs-2018-007894 ◽

2018 ◽

Vol 28 (5) ◽

pp. 366-373 ◽

Cited By ~ 10

Author(s):

Kevin J O’Leary ◽

Abra L Fant ◽

Jessica Thurk ◽

Karl Y Bilimoria ◽

Aashish K Didwania ◽

...

Keyword(s):

Quality Improvement ◽

Multiple Choice ◽

Training Programme ◽

Project Work ◽

Choice Test ◽

Multiple Choice Test ◽

Long Term Effects ◽

Before And After ◽

Applied Knowledge ◽

The Impact

BackgroundAlthough many studies of quality improvement (QI) education programmes report improvement in learners’ knowledge and confidence, the impact on learners’ future engagement in QI activities is largely unknown and few studies report project measures beyond completion of the programme.MethodWe developed the Academy for Quality and Safety Improvement (AQSI) to prepare individuals, across multiple departments and professions, to lead QI. The 7-month programme consisted of class work and team-based project work. We assessed participants’ knowledge using a multiple choice test and an adapted Quality Improvement Knowledge Assessment Test (QIKAT) before and after the programme. We evaluated participants’ postprogramme QI activity and project status using surveys at 6 and 18 months.ResultsOver 5 years, 172 individuals and 32 teams participated. Participants had higher multiple choice test (71.9±12.7 vs 79.4±13.2; p<0.001) and adapted QIKAT scores (55.7±16.3 vs 61.8±14.7; p<0.001) after the programme. The majority of participants at 6 months indicated that they had applied knowledge and skills learnt to improve quality in their clinical area (129/148; 87.2%) and to implement QI interventions (92/148; 62.2%). At 18 months, nearly half (48/101; 47.5%) had led other QI projects and many (41/101; 40.6%) had provided QI mentorship to others. Overall, 14 (43.8%) teams had positive postintervention results at AQSI completion and 20 (62.5%) had positive results at some point (ie, completion, 6 months or 18 months after AQSI).ConclusionsA team-based QI training programme resulted in a high degree of participants’ involvement in QI activities beyond completion of the programme. A majority of team projects showed improvement in project measures, often occurring after completion of the programme.

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Effectiveness of a short-structured training programme on knowledge of healthcare providers and programme managers involved in maternal and child health programmes in Odisha, India: a quality improvement study

BMJ Open ◽

10.1136/bmjopen-2020-040841 ◽

2021 ◽

Vol 11 (8) ◽

pp. e040841

Author(s):

Vikas Bhatia ◽

Arvind Kumar Singh ◽

Prajna Paramita Giri ◽

Durgesh Prasad Sahoo

Keyword(s):

Quality Improvement ◽

Child Health ◽

Neonatal Death ◽

Action Plan ◽

Healthcare Providers ◽

Knowledge Score ◽

Training Programme ◽

Effectiveness Of Training ◽

And Child Health ◽

Health Programmes

ObjectiveTo evaluate the effectiveness of training programme on knowledge related to new interventions proposed under India Newborn Action Plan (INAP) and Integrated Action Plan against Pneumonia and Diarrhoea (IAPPD).DesignQuality improvement study with pre-evaluation and post evaluation.SettingThe study was conducted in 17 districts of Odisha, India.Participants and interventionsThe participants were healthcare providers and programme managers involved in maternal and child health programmes. Intervention was a short-structured (8 hours) training delivered to 127 batches with expected participation of 30 trainees in each batch. Training was divided into four modules covering new interventions related to INAP and IAPPD like causes of neonatal death, kangaroo mother care (KMC), feeding of low birthweight (LBW) infants, use of injection gentamicin, identification of possible serious bacterial infection (PSBI), identification and management of pneumonia and diarrhoea and key interventions for maternal health. Various modalities of teaching-learning method were used.Outcome measuresPretraining and post-training knowledge assessment was done with a pretested tool consisting of 15 items. Each item carried equal weightage in calculation of knowledge score thus maximum possible knowledge score was 15. Feedback assessment was also done after the training.ResultsThe mean (SD) knowledge score significantly improved to 10.24 (2.24) after training as compared with 4.73 (1.94) before training, p<0.001 (n=982). There was significant improvement in knowledge for majority of the components namely causes of neonatal death (61.9% vs 28.1%), KMC (68.0% vs 54.6%), feeding of LBW infants (77.7% vs 6.9%), use of injection gentamicin (69.7% vs 11.2%), identification of PSBI (69.5% vs 59.5%). The improvement in knowledge score was more when healthcare providers and programme managers had provided a favourable response on feedback.ConclusionSystematic pretest and post-test assessment coupled with feedback assessment can ensure the effectiveness of training programmes offered in programmatic settings.

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Guidelines for implantation of a quality improvement training programme for health professionals in the ministry of health and social services in Namibia

International Journal of Health ◽

10.14419/ijh.v4i1.6111 ◽

2016 ◽

Vol 4 (1) ◽

pp. 54

Author(s):

Julia Paul Nangombe ◽

Hans Justus Amukugo

Keyword(s):

Health Care ◽

Quality Improvement ◽

Social Services ◽

Health Professionals ◽

Care Delivery ◽

Training Programme ◽

Health Care Facilities ◽

Successful Implementation ◽

Quality Health Care ◽

Care Facilities

This paper is focuses on the description of the guidelines for implantation of a quality improvement training programme for health professionals. The formulation of the guidelines also borrowed the CDC (2001) steps and UNFPA phases of developing the guidelines for successful implementation of the training programme at the health care facilities in the MoHSS. The facilitator(s) and implementers of the training programme are advised to first understand the background and the development process of the training programme for successful implementation. These guidelines have been developed to assist quality manager(s) and facilitator(s) with the implementation of the quality improvement training programme for health professionals at the health care facilities (MoHSS).The guidelines enhance consistency in steps and methods to be followed during the implementation of the programme. The guidelines were derived from the conceptual framework that was developed during the exploratory and situation analysis of quality health care delivery at the health care facilities. Two prominent theories were adapted in developing these guidelines. Firstly, Deming’s PDSA model of quality improvement and secondly, Kolb’s experiential learning theory. These theories were used to understand the teaching and learning styles. The guidelines outlined the process, activities, and elements required to implement the such programme.

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Paradigmatic perspective for a quality improvement training programme for health professionals in the ministry of health and social services in Namibia

International Journal of Health ◽

10.14419/ijh.v4i2.6164 ◽

2016 ◽

Vol 4 (2) ◽

pp. 89 ◽

Cited By ~ 2

Author(s):

Hans Justus Amukugo ◽

Julia Paul Nangombe

Keyword(s):

Health Care ◽

Quality Improvement ◽

Social Services ◽

Health Professionals ◽

Training Programme ◽

Health Care Facilities ◽

Ministry Of Health ◽

Quality Health Care ◽

Health And Social Services ◽

Quality Health

This article focuses on the paradigmatic perspective facilitate the development of a quality improvement training programme for health professionals in the ministry of health and social services in Namibia. The study of this nature requires a paradigmatic perspective; this is a collection of logically linked concepts and propositions that provide a theoretical perspective or orientation that tends to guide the research approach to a specific. Assumptions are useful in directing research decisions during the research process.The study adopted a constructivism and interpretivism approach, since it involved understand the current situation of quality health care/service delivery at health care facilities, and explore and describe the of the health professionals; experiences at the health care facilities. The study was based on the specific information that was accepted as true, as obtained from those lived the experiences of challenges and constraints of providing quality health care at the health care facilities.The paradigm perspectives in this study include Meta – theoretical assumption which consisted ontological, epistemological, axiological, methodological and rhetorical assumptions. Theoretical basis of the study includes Dickoff (1968), Practice Oriented Theory; Programme development by Meyer and Van Niekerk; Kolb’s Theory of experiential learning; Demining’s model of quality improvement, Quality improvement policy of the Ministry of Health and Social Services (MoHSS) and Centre for Diseases control (CDC) framework for programme education.

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Description of a quality improvement training programme for health professionals in the ministry of health and social services in Namibia

International Journal of Health ◽

10.14419/ijh.v4i1.6110 ◽

2016 ◽

Vol 4 (1) ◽

pp. 66

Author(s):

Julia Paul Nangombe ◽

Hans Justus Amukugo

Keyword(s):

Quality Improvement ◽

Conceptual Framework ◽

Social Services ◽

Health Professionals ◽

Training Programme ◽

Research Process ◽

Educational Programme ◽

Successful Implementation ◽

Ministry Of Health ◽

Health And Social Services

The aim of this paper is to describe the quality improvement training programme for health professionals in the Ministry of Health and Social Services in Namibia. The Practice Oriented Theory of Dickoff (1968) was used as practical guidelines to develop the conceptual framework. This framework was employed during the research and the educational programme development process. During the research process, the agent was the researcher; recipients (Managers/leadership and health professionals); the context (MoHSS head office and healthcare facilities); dynamics (findings for objective one and two); Procedure (research process) and terminus (foundations for development of educational programme). For the educational programme developing process, agent (quality specialist), recipients (health professional), context (health facilities), procedure (training programme for health professionals), dynamics, (challenges hampering successful implementation of the programme) and the terminus (knowledge, skills and abilities acquired through the training programme). During the development of the quality improvement training programme, two main theories were adapted. The most prominent one was a model by Meyer and Van Niekerk (2008), which was adapted to guide the process of developing the training programme. Kolb’s experiential learning theory was used to explain the learning process and styles of developing knowledge through experiences.The content of the training programme was derived from five main themes, 17 sub-themes and the conceptual framework based on the situation analysis about challenges faced by the health care facilities. The five themes were lack of implementation of policies and guidelines; inadequate resources; lack of interpersonal relationships; inadequate understanding of quality assurance and quality improvement; and inadequate research to provide evidence-based information during treatment and patient care.The educational programme consisted of the purpose / aim, objectives, structure / design, facilitation process, implementation process, and evaluation of the programme.

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Securing a cardiology speciality training programme in the UK: how did other people do it?

Postgraduate Medical Journal ◽

10.1136/postgradmedj-2017-135199 ◽

2017 ◽

Vol 94 (1109) ◽

pp. 155-158

Author(s):

Majd B Protty ◽

Kevin Mohee ◽

Hannah C Hoskins ◽

Hasan N Haboubi

Keyword(s):

Quality Improvement ◽

Teaching Experience ◽

Training Programme ◽

Freedom Of Information ◽

Freedom Of Information Act ◽

Academic Teaching ◽

Female Candidates ◽

Speciality Training ◽

Training Schemes ◽

The Uk

BackgroundApplication to cardiology specialty training is competitive with uncertainty among candidates as to what the secret recipe for a successful appointment is. We aimed to investigate objective variables, which were demonstrated by successful appointees to cardiology training schemes in the UK.MethodsData from successful cardiology applicants for the years 2014 to 2016 were obtained from the Joint Royal Colleges of Physicians Training Board under the Freedom of Information Act. These data included basic demographics as well as objective scores awarded for selection categories such as qualifications, academic, teaching and other achievements.ResultsThere were a total of 976 applicants during the study period, of whom 423 were successfully appointed, generating a competition ratio of 2.3 applicants for each position. There was an increasing proportion of successful female applicants (22% in 2014, 28% in 2015 and 32% in 2016). Median scores for postgraduate exams (14/14), presentations (6/6) and quality improvement (10/10) scores corresponded to maximum possible scores, whereas median scores for additional undergraduate and postgraduate degrees were 0. Median scores for prizes, publications and teaching experience were 6/10, 4/8 and 9/10, respectively.ConclusionThe secret to a successful cardiology training appointment is associated with completion of all postgraduate clinical exams, completion and presentation of quality improvement projects, national presentations and substantial teaching achievements. At least half of the successful candidates had no additional undergraduate or postgraduate degrees but had evidence of some prizes and publications. The ratio of successful female candidates is rising, but remains less than males in cardiology training.

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Developing the next generation of quality improvers: An evaluation of a region wide structured support quality improvement training programme

Clinical Risk ◽

10.1177/1356262216661469 ◽

2016 ◽

Vol 22 (3-4) ◽

pp. 51-56

Author(s):

Rob Bethune ◽

Mark Dahill ◽

Katherine Finucane ◽

Clare Van Hamel ◽

Joanne Watson ◽

...

Keyword(s):

Quality Improvement ◽

Training Programme ◽

Next Generation

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Development for a quality improvement training programme for health professionals in the ministry of health and social services in Namibia

International Journal of Health ◽

10.14419/ijh.v4i1.6108 ◽

2016 ◽

Vol 4 (1) ◽

pp. 40

Author(s):

Julia Paul Nangombe ◽

Hans Justus Amukugo

Keyword(s):

Health Care ◽

Quality Improvement ◽

Health Professionals ◽

Care Delivery ◽

Medical Science ◽

Training Programme ◽

Health Care Facilities ◽

Situational Analysis ◽

Programme Development ◽

Five Phases

The paper describes the steps followed in the development of a quality improvement training programme for health professionals. This was echoed by the facts that the health professionals are facing in their quest for quality health care delivery. In Namibia, most health care facilities have not been yielding good results in response to patients’ health care needs. Health care dynamics are complex and inundated with several factors; among others new methods, speed of improving medical science and technology, as well as increasing demands of the clients to address emerging and re-emerging diseases.In order to achieved that the five phases of programme development by Meyer and Van Niekerk (2008) were modified to facilitate the programme development. Quality improvement training for health professionals. Those five phases were situational analysis; conceptual framework; developing of the training programme; development of the guidelines for the implementation; and Evaluation of training programme.

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