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Interprofessional and multiprofessional approaches in quality improvement education

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Abstract

The imperative for all healthcare professionals to partake in quality improvement (QI) has resulted in the development of QI education programs with participants from different professional backgrounds. However, there is limited empirical and theoretical examination as to why, when and how interprofessional and multiprofessional education occurs in QI and the outcomes of these approaches. This paper reports on a qualitative collective case study of interprofessional and multiprofessional education in three longitudinal QI education programs. We conducted 58 interviews with learners, QI project coaches, program directors and institutional leads and 135 h of observations of in-class education sessions, and collected relevant documents such as course syllabi and handouts. We used an interpretive thematic analysis using a conventional and directed content analysis approach. In the directed content approach, we used sociology of professions theory with particular attention to professional socialization, hierarchies and boundaries in QI, to understand the ways in which individuals’ professional backgrounds informed the planning and experiences of the QI education programs. Findings demonstrated that both interprofessional and multiprofessional education approaches were being used to achieve different education objectives. While each approach demonstrated positive learning and practice outcomes, tensions related to the different ways in which professional groups are engaging in QI, power dynamics between professional groups, and disconnects between curricula and practice existed. Further conceptual clarity is essential for a more informed discussion about interprofessional and multiprofessional education approaches in QI and explicit attention is needed to professional processes and tensions, to optimize the impact of education on practice.

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References

  • Abbott, A. D. (1988). The system of professions. Chicago: University of Chicago Press.

    Google Scholar 

  • Allen, D. (2014). Lost in translation? ‘Evidence’ and the articulation of institutional logics in integrated care pathways: From positive to negative boundary object? Sociology of Health and Illness, 36(6), 807–822.

    Google Scholar 

  • Allen, D. (2015). Inside ‘bed management’: Ethnographic insights from the vantage point of UK hospital nurses. Sociology of Health and Illness, 37(3), 370–384.

    Google Scholar 

  • Allen, D., Braithwaite, J., Sandall, J., & Waring, J. (2016). Towards a sociology of healthcare safety and quality. Sociology of Health and Illness, 38(2), 181–197.

    Google Scholar 

  • American Association of Medical Colleges. (2019). Quality improvement and patient safety competencies. Retrieved June 2, 2020 from https://www.aamc.org/what-we-do/mission-areas/medical-education/cbme/qips.

  • Ayres, L., Kavanaugh, K., & Knafl, K. A. (2003). Within-case and across-case approaches to qualitative data analysis. Qualitative Health Research, 13(6), 871–883.

    Google Scholar 

  • Baily, M. A., Bottrell, M., Jennings, B., & Lynn, J. (2006). The ethics of using QI methods to improve health care quality and safety. A Hastings Center special report. Retrieved June 2, 2020 from http://www.thehastingscenter.org/wp-content/uploads/The-Ethics-of-Using-QI-Methods.pdf.

  • Baker, L., Egan-Lee, E., Martimianakis, M. A., & Reeves, S. (2011). Relationships of power: Implications for interprofessional education. Journal of Interprofessional Care, 25(2), 98–104.

    Google Scholar 

  • Baker, G. R., Norton, P. G., Flintoft, V., Blais, R., Brown, A., Cox, J., et al. (2004). The Canadian adverse events study: The incidence of adverse events among hospital patients in Canada. Canadian Medical Association Journal, 170(11), 1678–1686.

    Google Scholar 

  • Barry, A., Born, G., & Weszkalnys, G. (2008). Logics of interdisciplinarity. Economy and Society, 37, 20–49.

    Google Scholar 

  • Becker, H. S. (1963). Outsiders: Studies in the sociology of deviance. New York: Free Press.

    Google Scholar 

  • Becker, H. S., Geer, B., Hughes, E. C., & Strauss, A. L. (1961). Boys in white: Student culture in medical school. Chicago: The University of Chicago Press.

    Google Scholar 

  • Berwick, D. (2013). A promise to learn—a commitment to act: Improving the safety of patients in England. National Advisory Group on the Safety of Patients in England. Retrieved June 2, 2020 from https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/226703/Berwick_Report.pdf.

  • Bosk, C. (2003). Forgive and remember: Managing medical failure. Chicago: University of Chicago Press.

    Google Scholar 

  • Brandt, B. F., Kitto, S., & Cervero, R. M. (2018). Untying the interprofessional Gordian Knot: The National Collaborative for Improving the Clinical Learning Environment. Academic Medicine, 93(10), 1437–1440.

    Google Scholar 

  • Braun, V., Clarke, V., Hayfield, N., & Terry, G. (2019). Thematic analysis. In P. Liamputtong (Ed.), Handbook of research methods in health social sciences. Singapore: Springer.

    Google Scholar 

  • Centre for the Advancement of Interprofessional Education. (2017). Interprofesional education guidelines. Retrieved June 2, 2020 from https://www.caipe.org/resources/publications/caipe-publications/caipe-2017-interprofessional-education-guidelines-barr-h-ford-j-gray-r-helme-m-hutchings-m-low-h-machin-reeves-s.

  • Cooper, R. J., Bissell, P., Ward, P., Murphy, E., Anderson, C., Avery, T., et al. (2012). Further challenges to medical dominance? The case of nurse and pharmacist supplementary prescribing. Health (London), 16(2), 115–133.

    Google Scholar 

  • Cribb, A. (2018). Improvement science meets improvement scholarship: Reframing research for better healthcare. Health Care Analysis, 26(2), 109–123.

    Google Scholar 

  • Cronenwett, L., Sherwood, G., Barnsteiner, J., Disch, J., Johnson, J., Mitchell, P., et al. (2007). Quality and safety education for nurses. Nursing Outlook, 55, 122–131.

    Google Scholar 

  • Crowe, S., Cresswell, K., Robertson, A., Huby, G., Avery, A., & Sheikh, A. (2011). The case study approach. BMC Medical Research Methodology, 11, 100.

    Google Scholar 

  • Dixon-Woods, M., Campbell, A., Martin, G., Willars, J., Tarrant, C., Aveling, E. L., et al. (2019). Improving employee voice about transgressive or disruptive behavior: A case study. Academic Medicine, 94(4), 579–585.

    Google Scholar 

  • Dixon-Woods, M., Suokas, A., Pitchforth, E., & Tarrant, C. (2009). An ethnographic study of classifying and accounting for risk at the sharp end of medical wards. Social Science and Medicine, 69(3), 362–369.

    Google Scholar 

  • Farr, M., & Cressey, P. (2015). Understanding staff perspectives of quality in practice in healthcare. BMC Health Services Research, 15, 123.

    Google Scholar 

  • Flick, U. (1992). Triangulation revisited: Strategy of validation or alternative? Journal for the Theory of Social Behaviour, 22(2), 175–197.

    Google Scholar 

  • Fourcade, A., Blache, J. L., Grenier, C., Bourgain, J. L., & Minvielle, E. (2012). Barriers to staff adoption of a surgical safety checklist. BMJ Quality and Safety, 21(3), 191–197.

    Google Scholar 

  • Freidson, E. (1988). Profession of medicine: A study of the sociology of applied knowledge. Chicago: The University of Chicago Press.

    Google Scholar 

  • Gleason, K. T., VanGraafeiland, B., Commodore-Mensah, Y., Walrath, J., Immelt, S., Ray, E., et al. (2019). The impact of an innovative curriculum to introduce patient safety and quality improvement content. BMC Medical Education, 19(1), 156.

    Google Scholar 

  • Goldman, J., Kitto, S., & Reeves, S. (2018). Examining the implementation of collaborative competencies in a critical care setting: Key challenges for enacting competency-based education. Journal of Interprofessional Care, 32(4), 407–415.

    Google Scholar 

  • Goldman, J., Kuper, A., Baker, R., Bulmer, B., Coffey, M., Jeffs, L., et al. (2020). Experiential learning in project-based quality improvement education: questioning assumptions and identifying future directions. Academic Medicine.

  • Green, J., & Thorogood, N. (2004). Qualitative methods for health research. London: SAGE Publications Ltd.

    Google Scholar 

  • Haas, J., & Shaffir, W. (1982). Ritual evaluation of competence: The hidden curriculum of professionalization in an innovative medical school program. Work and Occupations, 9(2), 131–154.

    Google Scholar 

  • Hafferty, F. W. (2009). Professionalism and the socialization of medical students. In R. L. Cruess, S. R. Cruess, & Y. Steinert (Eds.), Teaching medical professionalism: Supporting the development of a professional identity. Cambridge: Cambridge University Press.

    Google Scholar 

  • Hafferty, F. W., & O’Donnell, J. F. (2014). The next generation of work on the hidden curriculum: Concluding thoughts. In F. W. Hafferty & J. F. O’Donnell (Eds.), The hidden curriculum in health professional education. Hanover: Dartmouth College Press.

    Google Scholar 

  • Harrod, M., Kowalski, C. P., Saint, S., Forman, J., & Krein, S. L. (2013). Variations in risk perceptions: A qualitative study of why unnecessary urinary catheter use continues to be problematic. BMC Health Services Research., 13, 151.

    Google Scholar 

  • Hsieh, H. F., & Shannon, S. E. (2005). Three approaches to qualitative content analysis. Qualitative Health Research, 15(9), 1277–1288.

    Google Scholar 

  • Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, D.C.: National Academies Press.

    Google Scholar 

  • Institute of Medicine. (2003). Health professions education: A bridge to quality. Washington, D.C.: National Academies Press.

    Google Scholar 

  • Kaminski, G. M., Britto, M. T., Schoettker, P. J., Farber, S. L., Muething, S., & Kotagal, U. R. (2012). Developing capable quality improvement leaders. BMJ Quality and Safety, 21(11), 903–911.

    Google Scholar 

  • Kitto, S., Marshall, S. D., McMillan, S. E., Shearer, B., Buist, M., Grant, R., et al. (2015). Rapid response systems and collective (in)competence: An exploratory analysis of intraprofessional and interprofessional activation factors. Journal of Interprofessional Care, 29(4), 340–346.

    Google Scholar 

  • Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Washington, D.C.: National Academy Press.

    Google Scholar 

  • Kuper, A., Veinot, P., Leavitt, J., Levitt, S., Li, A., Goguen, J., et al. (2017). Epistemology, culture, justice and power: Non-bioscientific knowledge for medical training. Medical Education, 51(2), 158–173.

    Google Scholar 

  • Kuper, A., & Whitehead, C. (2012). The paradox of interprofessional education: IPE as a mechanism of maintaining physician power? Journal of Interprofessional Care, 26(5), 347–349.

    Google Scholar 

  • Lamont, M., & Molnar, V. (2002). The study of boundaries in the social sciences. Annual Review of Sociology, 28, 167–195.

    Google Scholar 

  • Larson, S. M. (1990). In the matter of experts and professionals or how impossible it is to leave nothing unsaid. In R. Torstendahl & M. Burrage (Eds.), The formation of professions: Knowledge, state and strategy. London: Sage.

    Google Scholar 

  • Liberati, E. G. (2017). Separating, replacing, intersecting: The influence of context on the construction of the medical-nursing boundary. Social Science and Medicine, 172, 135–143.

    Google Scholar 

  • Liberati, E. G., Gorli, M., & Scaratti, G. (2016). Invisible walls within multidisciplinary teams: Disciplinary boundaries and their effects on integrated care. Social Science and Medicine, 150, 31–39.

    Google Scholar 

  • Light, D. (1979). Uncertainty and control in professional training. Journal of Health and Social Behvior, 20(4), 310–322.

    Google Scholar 

  • Lim, A. G., North, N., & Shaw, J. (2017). Navigating professional and prescribing boundaries: Implementing nurse prescribing in New Zealand. Nurse Education in Practice, 27, 1–6.

    Google Scholar 

  • Macdonald, K. M. (1995). The sociology of the professions. London: Sage Publications.

    Google Scholar 

  • Mackintosh, N., & Sandall, J. (2010). Overcoming gendered and professional hierarchies in order to facilitate escalation of care in emergency situations: The role of standardised communication protocols. Socical Science and Medicine, 71(9), 1683–1686.

    Google Scholar 

  • Martin, G. P., & Waring, J. (2013). Leading from the middle: Constrained realities of clinical leadership in healthcare organizations. Health (London), 17(4), 358–374.

    Google Scholar 

  • McDonald, R., Waring, J., & Harrison, S. (2006). Rules, safety and the narrativisation of identity: A hospital operating theatre case study. Sociology of Health and Illness, 28(2), 178–202.

    Google Scholar 

  • McGivern, G., Currie, G., Ferlie, E., Fitzgerald, L., & Waring, J. (2015). Hybrid manager-professionals’ identity work: The maintenance and hybridization of medical professionalism in managerial contexts. Public Administration, 93(2), 412–432.

    Google Scholar 

  • Merton, R. K. (1957). Some preliminaries to a sociology of medical education. In R. K. Merton, G. G. Reader, & P. L. Kendall (Eds.), The student physician: Introductory studies in the sociology of medical education. Cambridge: Harvard University Press.

    Google Scholar 

  • Meyer, C. B. (2001). A case in case study methodology. Field Methods, 13(4), 329–352.

    Google Scholar 

  • Mitzkat, A., Berger, S., Reeves, S., & Mahler, C. (2016). More terminological clarity in the interprofessional field—a call for reflection on the use of terminologies, in both practice and research, on a national and international level. GMS Journal for Medical Education, 33(2), 36.

    Google Scholar 

  • Nancarrow, S. A., & Borthwick, A. M. (2005). Dynamic professional boundaries in the healthcare workforce. Sociology of Health and Illness, 27(7), 897–919.

    Google Scholar 

  • Noordegraaf, M. (2015). Hybrid professionalism and beyond: (New) Forms of public professionalism in changing organizational and societal contexts. Journal of Professions and Organization, 2(2), 187–206.

    Google Scholar 

  • O’Leary, K. J., Fant, A. L., Thurk, J., Bilimoria, K. Y., Didwania, A. K., Gleason, K. M., et al. (2019). Immediate and long-term effects of a team-based quality improvement training programme. BMJ Quality and Safety, 28, 366–373.

    Google Scholar 

  • Olson, R. E., & Brosnan, C. (2017). Examining interprofessional education through the lens of interdisciplinarity: Power, knowledge and new ontological subjects. Minerva, 55(3), 299–319.

    Google Scholar 

  • Paradis, E., & Whitehead, C. R. (2015). Louder than words: Power and conflict in interprofessional education articles, 1954–2013. Medical Education, 49(4), 399–407.

    Google Scholar 

  • Patrician, P. A., Dolansky, M., Estrada, C., Brennan, C., Miltner, R., Newsom, J., et al. (2012). Interprofessional education in action: The VA Quality Scholars fellowship program. The Nursing Clinics of North America, 47(3), 347–354.

    Google Scholar 

  • Patton, M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks: Sage Publications Ltd.

    Google Scholar 

  • Reeves, S. (2011). Using the sociological imagination to explore the nature of interprofessional interactions and relations. In S. Kitto, J. Chesters, J. Thistlethwaite, & S. Reeves (Eds.), Sociology of interprofessional health care practice: Critical reflections and concrete solutions. New York: Nova Science Publishers.

    Google Scholar 

  • Reeves, S., Clark, E., Lawton, S., Ream, M., & Ross, F. (2017). Examining the nature of interprofessional interventions designed to promote patient safety: A narrative review. International Journal for Quality in Health Care, 29(2), 144–150.

    Google Scholar 

  • Reeves, S., Goldman, J., & Oandasan, I. (2007). Key factors in planning and implementing interprofessional education in health care settings. Journal of Allied Health, 36(4), 231–235.

    Google Scholar 

  • Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Koppel, I., et al. (2010). The effectiveness of interprofessional education: Key findings from a new systematic review. Journal of Interprofessional Care, 24(3), 230–241.

    Google Scholar 

  • Rowland, P., Lising, D., Sinclair, L., & Baker, G. R. (2018). Team dynamics within quality improvement teams: A scoping review. International Journal for Quality in Health Care, 30(6), 416–422.

    Google Scholar 

  • Royal College of Physicians and Surgeons of Canada. (2015). CanMEDS patient safety and quality improvement. Retrieved June 2, 2020 from http://www.royalcollege.ca/rcsite/canmeds/framework/patient-safety-quality-improvement-e.

  • Sanders, T., & Harrison, S. (2008). Professional legitimacy claims in the multidisciplinary workplace: The case of heart failure care. Sociology of Health and Illness, 30(2), 289–308.

    Google Scholar 

  • Shojania, K. G., & Levinson, W. (2009). Clinicians in quality improvement: A new career pathway in academic medicine. JAMA, 301(7), 766–768.

    Google Scholar 

  • Simons, H. (2009). Case study research in practice. London: SAGE.

    Google Scholar 

  • Sonnenberg, M. (2018). Changing roles and skill sets for chief medical officers. Retrieved June 2, 2020 from https://www.physicianleaders.org/news/changing-roles-skill-sets-chief-medical-officers.

  • Spradley, J. (1979). The ethnographic interview. New York: Holt.

    Google Scholar 

  • Stake, R. (2000). Case studies. In N. K. Denzin & Y. S. Lincoln (Eds.), Handbook of qualitative research. Thousand Oaks: Sage.

    Google Scholar 

  • Tarrant, C., O’Donnell, B., Martin, G., Bion, J., Hunter, A., & Rooney, K. D. (2016). A complex endeavour: An ethnographic study of the implementation of the Sepsis Six clinical care bundle. Implementation Science, 11, 149.

    Google Scholar 

  • Thomas, E. J., Studdert, D. M., Burstin, H. R., Orav, J., Zeena, T., Williams, E. J., et al. (2000). Incidence and types of adverse events and negligent care in Utah and Colorado. Medical Care, 38(3), 261–271.

    Google Scholar 

  • Veazey Brooks, J., & Bosk, C. L. (2012). Remaking surgical socialization: Work hour restrictions, rites of passage, and occupational identity. Social Science and Medicine, 75(9), 1625–1632.

    Google Scholar 

  • Vincent, C., Neale, G., & Woloshynowych, M. (2001). Adverse events in British hospitals: Preliminary retrospective record review. British Medical Journal, 322(7285), 517–519.

    Google Scholar 

  • Waring, J., Allen, D., Braithwaite, J., & Sandall, J. (2016). Healthcare quality and safety: A review of policy, practice and research. Sociology of Health and Illness, 38(2), 198–215.

    Google Scholar 

  • Willis, E. (1989). Medical dominance: The division of labour in Australian health care. Sydney: Allen & Unwin.

    Google Scholar 

  • Witz, A. (1990). Patriarchy and professions: The gendered politics of occupational closure. Sociology, 24, 675–690.

    Google Scholar 

  • Wong, B. M., & Holmboe, E. S. (2016). Transforming the academic faculty perspective in graduate medical education to better align educational and clinical outcomes. Academic Medicine, 91(4), 473–479.

    Google Scholar 

  • Xyrichis, A., Lowton, K., & Rafferty, A. M. (2017). Accomplishing professional jurisdiction in intensive care: An ethnographic study of three units. Social Science and Medicine, 181, 102–111.

    Google Scholar 

  • Zoutman, D. W., & Ford, B. D. (2017). Quality improvement in hospitals: Barriers and facilitators. International Journal of Health Care Qualtiy Assurance, 30(1), 16–24.

    Google Scholar 

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Acknowledgements

This study was funded by a Medical Education Research Grant provided by the Royal College of Physicians and Surgeons of Canada. We would like to thank the learners, project coaches, teachers, program directors and institutional leaders who participated in this study.

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Authors and Affiliations

  1. Centre for Quality Improvement and Patient Safety, University of Toronto, 525 University Ave., Suite 630, Toronto, ON, M5G 2L3, Canada

    Joanne Goldman, Kaveh Shojania & Brian Wong

  2. Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada

    Joanne Goldman, Ayelet Kuper, Kaveh Shojania & Brian Wong

  3. Wilson Centre for Research in Education, University of Toronto, Toronto, Canada

    Joanne Goldman, Ayelet Kuper & Cynthia Whitehead

  4. Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada

    Ayelet Kuper, Kaveh Shojania & Brian Wong

  5. Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada

    Cynthia Whitehead

  6. Women’s College Hospital, Toronto, Canada

    Cynthia Whitehead

  7. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    G. Ross Baker, Christine Shea & Lianne Jeffs

  8. St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada

    Beverly Bulmer

  9. Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada

    Beverly Bulmer

  10. Department of Paediatrics, University of Toronto, Toronto, Canada

    Maitreya Coffey

  11. The Hospital for Sick Children, Toronto, Canada

    Maitreya Coffey

  12. Children’s Hospitals Solutions for Patient Safety, Cincinnati, OH, USA

    Maitreya Coffey

  13. Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Canada

    Lianne Jeffs

  14. Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada

    Lianne Jeffs

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  1. Joanne Goldman
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Goldman, J., Kuper, A., Whitehead, C. et al. Interprofessional and multiprofessional approaches in quality improvement education. Adv in Health Sci Educ 26, 615–636 (2021). https://doi.org/10.1007/s10459-020-10004-z

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