Use of Institute for Healthcare Improvement (IHI) Open School Courses in a Prelicensure Nursing Program
Assistant Professor of Nursing
Western Carolina University
Patient-Centered Care, Quality Improvement, Safety, Teamwork and Collaboration
Online or Web-based Modules
1. Value seeing health care situations “through patients’ eyes.” Respect and encourage individual expression of patient values, preferences and expressed needs. [patient centered care]
2. Acknowledge own potential to contribute to effective team functioning. Appreciate importance of intra- and inter-professional collaboration. [teamwork and collaboration]
3. Discuss effective strategies for communicating and resolving conflict. [teamwork and collaboration]
4. Choose communication styles that diminish the risks associated with authority gradients among team members. [teamwork and communication]
5. Value the influence of system solutions in achieving effective team functioning. [teamwork and communication]
6. Recognize that nursing and other health professions students are parts of systems of care and care processes that affect outcomes for patients and families. [quality improvement]
7. Use tools (such as flow charts, cause-effect diagrams) to make processes of care explicit. [quality improvement]
8. Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as, work-arounds (shortcuts or breaks in standard processes) and dangerous abbreviations) [safety]
9. Delineate general categories of errors and hazards in care. Describe factors that create a culture of safety (such as, open communication strategies and organizational error reporting systems) [safety]
Several Institute for Healthcare Improvement (IHI) Open School courses are completed by students in a leadership and management course during the last semester of a traditional and accelerated BSN program. Students independently complete IHI courses in patient safety and leadership, including: Introduction to Patient Safety, Fundamentals of Patient Safety, Human Factors and Safety and Communicating with Patients after Adverse Events, and Leadership (L101) So You Want to be a Leader in Healthcare throughout the semester. Content from the courses are incorporated into class activities and discussions, written assignments and course test questions.
Learning Strategies related to IHI Open School Courses on Patient Safety:
1) One activity competed in class after students complete the patient safety courses is to have students write on post it notes to place on posters in the classroom. One poster is dedicated to what students learned by completing the IHI Patient Safety Courses, and the other poster is for students to add "how they felt" after completing these courses. To initiate discussion in the class, each student is asked to complete at least two post it notes (they may complete more) related to the IHI Patient Safety Open School courses. On one post it note students write at least one thing they learned by completed the Open School course, and one post it note on how completing the courses made them feel. The post it notes are placed on poster paper in the room. The instructor summarizes some of the most common responses on each poster, and facilitates discussion on common topics. Some common learning points identified by students are: “just culture”, causes of errors – human and system factors, how common errors are in healthcare, etc. Frequently students identify “how they feel” after the modules as: “afraid I will make an error that hurts someone”, “heartbroken for families that have been effected by errors.” Adequate class time for discussion is needed to process learning points and student fears and anxiety related to patient safety.
2) A cause and effect (fishbone) diagram is used in class after the patient safety modules are completed, to outline the causes of one scenario/situation presented in the IHI course. An airline crash scenario video in one of the modules is used to identify contributing factors of the crash, including communication, hierarchy/organizational culture, environmental factors, fatigue, stress. Students are then asked to describe an error or near miss they may have witnesses in the clinical environment, and discuss similar/contrasting factors leading to the error or near miss.
3) The students complete a patient interview assignment (attached) to gain understanding of a patient's perspective of a healthcare experience based on the IOM 6 Domains. During the course content and lecture period on patient centered care, the students discuss findings from their patient interviews. Data from patient interviews is compiled during class, including the types of care units, clinics where the patient experienced care, and themes of what constituted "good" or "bad" nursing care as perceived by patients and families. A review and discussion of learning from the IHI course related to completing a patient apology (IHI Course PS 105) is also completed during this class period. Students are divided into small groups with at least one student with a patient story with an untoward outcome or dissatisfaction with care. In small groups the students construct a patient (or family) apology based on the individual circumstances of the patient story and using principles of delivering an effective apology. Each small group then presents a brief summary of the patient experience, and delivers an apology to the patient or family member. The remainder of the class listens and critiques the apology.
4) Students also complete a paper (assignment attached) after completing the IHI leadership course. The IHI leadership course addresses being a leader in a system, and taking a leadership stance in difficult situations, no matter the official role or title. The course also addresses inter-professional communication and relationships. The purpose of the assignment based on the IHI course, is to have the student describe a past experience or situation in a job or school situation, and analyze how they could have handled the situation differently based on concepts learned in the IHI leadership course.
1. Course exams include specific questions related to IHI courses.
2. Patient Interview Assignment (attached)
3. Leadership Assignment (attached)
4. Class discussions and participation in activities
End of course evaluations indicate that students find the IHI courses relevant, interesting and add value to the nursing leadership course. The IHI "So You Want to be a Leader" Course (LD 100) has been mentioned most often by students as the most helpful, well presented and important IHI course they completed. The unfolding case study very clearly demonstrated how to approach an issue and address it as a "leader" in a health care situation.
Students scored well on exam questions related to content covered in the IHI courses - scoring higher on those content areas than those presented through other methods (readings in the text, presentations in class) in the course.
Each assignment included a section on learning points from the assignment. Comments added by students showed changes in attitudes and values related to patient safety and leadership.