Runnacles Jane, Moult Beki, Lachman Peter
Quality, Safety and Transformation team, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
BMJ Qual Saf. 2013 Nov;22(11):956-63. doi: 10.1136/bmjqs-2012-001718. Epub 2013 Jul 9.
Medical training does not necessarily prepare graduates for the real world of healthcare in which continual improvement is required. Doctors in postgraduate training (DrPGT) rarely have the opportunity to develop skills to implement changes where they work. Paradoxically they are often best placed to identify safety and quality concerns and can innovate across organisational boundaries. In order to address this, educational programmes require a supportive educational environment and should include experiential learning on a safety and quality project, alongside teaching of quality improvement (QI) knowledge and systems theory.
Enabling Doctors in Quality Improvement and Patient Safety (EQuIP) has been designed for DrPGT at a London children's hospital. The aim is to prepare trainees for the future of continual improvement to ensure safe and effective services are developed through effective clinical microsystems. This paper describes the rationale and design of EQuIP with evaluation built in the evolving programme. EQuIP supports DrPGTs through a QI project within their department, aligned to the Great Ormond Street NHS Foundation Trust's objectives. This changes the way DrPGTs view healthcare as they become quality champions for their department. A three-level approach to the programme is described. The innovation involves a peer-designed programme while being work-based, delivering organisational strategies.
Results of the preprogramme and postprogramme evaluations demonstrate an improvement in knowledge, skills and attitudes. Benefits to both the DrPGTs and the organisation are emphasised and key factors to achieve success and barriers identified by the participants.
The design and evaluation of EQuIP may inform similar educational programmes in other organisations. This capacity building is crucial to ensure that future clinical leaders have the skills and motivation to improve the effectiveness of clinical microsystems.
医学培训并不一定能让毕业生为需要持续改进的现实医疗环境做好准备。接受研究生培训的医生（DrPGT）很少有机会培养在工作中实施变革的技能。矛盾的是，他们往往最有条件识别安全和质量问题，并且能够跨越组织边界进行创新。为了解决这一问题，教育项目需要一个支持性的教育环境，应包括关于安全和质量项目的体验式学习，以及质量改进（QI）知识和系统理论的教学。
“提升质量改进与患者安全能力的医生培训项目”（EQuIP）是为伦敦一家儿童医院的DrPGT设计的。其目的是让学员为持续改进的未来做好准备，以确保通过有效的临床微系统开发出安全有效的服务。本文描述了EQuIP的基本原理和设计，并在不断发展的项目中进行评估。EQuIP通过其所在部门内的一个QI项目支持DrPGT，该项目与大奥蒙德街国民保健服务基金会信托基金的目标相一致。这改变了DrPGT看待医疗保健的方式，因为他们成为了所在部门的质量倡导者。文中描述了该项目的三级方法。该创新涉及一个由同行设计、基于工作的项目，以实现组织战略。
项目前和项目后的评估结果表明，学员在知识、技能和态度方面有所改进。强调了对DrPGT和组织的益处，以及参与者确定的取得成功的关键因素和障碍。
EQuIP的设计和评估可能会为其他组织的类似教育项目提供参考。这种能力建设对于确保未来的临床领导者具备提高临床微系统有效性的技能和动力至关重要。
