'DISSONANCE' and 10 Strategies to Align Health Worker Education and Training with Quality & Safety Priorities

Teacher from med school/old classmate/senior colleagues in the medical field: "What do you do for a living?"

Me: "I am in quality management and a patient safety professional. I work in many industries but my passion is in the health and healthcare sector."

Teacher from med school/old classmate/senior colleagues in the medical field: "quality what? what does that even mean?"[almost always unable to hide the quizzical look].

This scenario plays out 8 out of every 10 times that I get asked that question in the last 18 plus years.

Lately, more and more healthcare workers, especially in Africa have had more exposure to quality and safety in one form or another (my sentiments).

Perhaps, there was a time when there was no consensus over the importance of quality and safety in healthcare. Not anymore. There might even be lingering arguments about quality frameworks and preferences on which are the most efficient safety methodologies, but more people now agree that quality and safety are not just nice-to-haves in the architecture of a health system that will produce the expected results.

However, despite the seeming interest in these critical-to-success practices of quality and safety, there exists a noticeable chasm in the realm of health worker education and training. While 'Quality Improvement' (QI) and 'Patient Safety' (PS) dominate modern healthcare dialogues, there's a perplexing omission of these core principles in many health worker training curricula. This raises the question: Why the dissonance between our conversations and our curricula??

It certainly is a cocktail of potential causes:

The Question of Commitment: Are we “genuinely” committed to transforming health worker education? Or is our collective enthusiasm for QI and PS merely aspirational, not yet ready to transition into actionable change? Could it be that as a community, we're enthralled by the idea of QI and PS but are perhaps not fully ready to walk the talk? Or maybe, we're simply playing hard to get? Perhaps we are not yet convinced about the transformative power of embedding these concepts into curricula??

The Expertise Shortfall: The absence of educators adept in QI and Patient Safety principles might be creating a void. It underscores the need for specialization and capacity-building within the academic community. I tag this the 'Expert' Dilemma and it reminds me of the tricky puzzles where one missing piece throws the entire game off! Maybe we lack that crucial piece: educators proficient in the arts of QI and Patient Safety.

Curriculum Overload: Healthcare curricula are undoubtedly expansive and rigorous. The reluctance could stem from concerns about overburdening students and diluting the essence of existing courses. I dubbed this one the 'Heavy Backpack' Syndrome - our curricula are already akin to a backpacker's overloaded bag. The hesitancy could be adding yet another textbook to that proverbial bag, fearing a tipping point (both metaphorically and literally). The fear of burdening students with yet another layer of learning, given the voluminous content they are already exposed to.

The Immediate vs. The Important: Are we so engrossed in addressing the immediate needs of current professionals that we've inadvertently neglected the foundational integration for future generations? This firefighter approach of dousing current fires (or retraining existing professionals) has kept us so occupied that the idea of fire prevention (incorporating these principles from day one) has been placed on the back burner. With a vast majority of resources dedicated to retraining current practitioners, have we overlooked the vital importance of sowing these seeds early in a healthcare worker's education? These are the ones I call the “Bandwidth challenges”.

But what can we do differently and how can we get that done? Bridging the identified gaps in integrating 'Quality Improvement' (QI) and 'Patient Safety' into health worker training and education requires a multi-faceted approach.

The following strategies are a good place to start:

Strategy #1. Stakeholder Collaboration – This is not just about physicians or nurses alone. All relevant training institutions and regulatory bodies. We must facilitate dialog between universities, hospitals, accrediting bodies, and professional associations to emphasize the importance of QI and Patient Safety in curricula. By securing commitment from all relevant stakeholders, it becomes easier to drive systemic change from all angles.?

Strategy #2. Curriculum Overhaul - Talk is cheap so we must move the needle in the right direction by incorporating QI and Patient Safety as mandatory modules or courses within health worker training programs. These should not be mere elective choices but integral components of the training curriculum.?

Strategy #3. Train the Trainer/Tutor – Our investments in the training programs will fail to yield optimally except we also invest in specialized training for educators, enabling them to effectively teach QI and Patient Safety. This could involve certifications, workshops, or even advanced degrees centered around these competencies.?

Strategy #4. Experiential Learning – Nothing yields better learning than the opportunity to do what is being learnt. Hence, beyond classroom teaching, students should participate in practical simulations, case studies, and hospital rotations focused specifically on quality and safety issues.

Strategy #5. Feedback Loops – Make communication a two-way street by establishing the mechanisms for students and educators to provide feedback on the effectiveness of QI and Patient Safety training. Continuous feedback will ensure the curriculum remains relevant and effective.

Strategy #6. Research and Development: Encourage research on best practices, pedagogies, and outcomes related to QI and Patient Safety education. Research-backed evidence can further underline the importance of these fields, while providing empirical evidence that QI and PS works.

Strategy #7. Accreditation Standards: Regulation is critical in this equation and accrediting bodies should mandate the inclusion of QI and Patient Safety in the core curriculum for health worker training programs. Institutions should meet these standards to be accredited, ensuring uniformity across programs.

Strategy #8. Continuing Education: Recognize that healthcare is an evolving field. Professionals already in the field might have missed out on this specialized training during their formal education. Offer short-term courses, workshops, and seminars to fill this knowledge gap.

Strategy #9. Awareness Campaigns: Elevate the importance of QI and Patient Safety in healthcare through seminars, webinars, conferences, and public campaigns. When there's a broader understanding and demand for these principles, institutions are more likely to prioritize them.

Strategy #10. Evaluation and Metrics: Regularly evaluate the effectiveness of the revised curriculum. Implement metrics to gauge improvements in patient outcomes, reduced errors, and other indicators as a result of better education in QI and Patient Safety. [this certainly has to be another article]

Bridging this particular know-do gap requires a synergy of updated curriculum content, skilled educators, practical exposure, and ongoing evaluations. With collective and persistent effort, we can ensure that the next generation of healthcare professionals is not only well-versed in their specialties but also champions the principles of quality and safety.

Call to Action

Disruption often begins with the uncomfortable acknowledgment of what’s missing. The very essence of innovation is rooted in addressing gaps, not merely adapting to them. This is the time for change. Let us evolve towards integrating Quality Improvement and Patient Safety right from the foundational years of health worker training and education.

In this pivotal moment for introspection, we must align our pedagogical strategies with the demands and expectations of modern healthcare. It's time to sow the seeds of 'patient-first' and 'quality-centric' care right from the inception of a healthcare professional's journey. This will allow us to produce healthcare professionals who are not just well-versed in their specialties but are also deeply rooted in the principles of patient-first, quality-driven care.

The future beckons us to not only adapt but also lead with vision. Let's rise to the occasion and shape robust, relevant, and responsive health worker education and training systems.?

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