Integrate quality improvement in medical training

An MRI scanner. [iStockphoto] A workforce's skill level is a major factor in a health system's effectiveness. Healthcare has evolved immensely in recent years; we have increased knowledge about diseases, better diagnosis, including point-of-care tests that increased efficiencies, and improved accuracy and over time developed technologies enabling minimal access to surgeries. Training of the health workforce globally and in Kenya has also grown. However, gaps still exist in how quality improvement and patient safety are integrated into formal training. It is time to educate healthcare professionals on quality improvement and patient safety principles and concepts. When their competencies are strengthened, we build the resilience required for healthcare workers operating in diverse environments to translate the inputs in healthcare such as policies, human, materials and financial resources to the desired outcomes that include reduced mortality, reduced length of stay, reduced hospital-acquired infections, adverse incidents or harm, reduced emergency admissions and improved patient experience. In Kenya, training of nurses and doctors for instance has been highly structured, with government institutions such as the Kenya Medical Training College driving the process for some healthcare workers. Private healthcare organisations such as Nairobi Hospital and Aga Khan University have also rolled out their training programmes to augment efforts to meet the country's health workforce availability. Although a few entries on quality and safety have been made in the healthcare management graduate courses, none had quality and safety training sufficiently integrated into the clinical curriculum as examinable subjects. In Kenya, only the Aga Khan University hospital, has international certification for post-graduate education of ACGME with a quality improvement and patient safety programme. To accelerate efforts in assisting universities and schools of health sciences build and integrate quality of care and patient safety into learning, the World Health Organisation (WHO) has given guidance through the Patient Safety Curriculum Guide of 2011, the Global Learning Laboratory that shares materials on the science of quality improvement. It is comprehensive to address healthcare educators and students. Since faculty for these trainings are not always available, existing faculty can use the guide to develop them into quality improvement and patient safety educators. Authors of the guide point out that 'QI should become a basic skill like cardiopulmonary resuscitation; one that all health professionals acquire early in their training as an integral part of their future work. When everyone shares this basic understanding, communication and collaboration become easier, and continuous improvement throughout the workplace becomes a habit. The skills themselves are transferrable across any discipline. Creating capacity so that staff are able and encouraged to ask and respond to the question 'what can I do to make a difference?' without having to wait to be asked, has the power to empower and counteract the feeling of 'learned helplessness''. Fortunately, the Kenya Quality Model for Health (KQMH) has already designed the KQMH course to guide public health workers and empower them with capacity to design, plan, and implement quality management systems. Credit goes to Dr Charles Kandie and Dr Aisha Muhamed from the Directorate of Health Standards Quality Assurance and Regulation at the Ministry of Health for driving QI training that goes with the KQMH standard. During the recent Quality Improvement leadership forum in Nairobi, they noted that the 47 counties are eager for support to gain much-needed skills. Public health facilities like the Kenyatta National Hospital have been running quality improvement in-service training for executives. -The writer is Director of Healthcare Quality at the Kenyatta National Hospital

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