The evolution of the Improving Health Care course

M. Rashad Massoud

Director, USAID ASSIST Project/URC

A story of continuous quality improvement

Last month, we released an eLearning course providing the same curriculum used to orient USAID ASSIST Project headquarters staff and Chief of Parties to improvement. While the availability of this material in an online course is new, the vast experience on which the course is based on goes back decades. This is the story of the Improving Health Care course.

What is this course about?

This interactive virtual course provides the same curriculum used to orient USAID ASSIST Project headquarters staff and Chief of Parties to improvement. The course is structured to give a broad overview of the science of improvement, going over key principles and methods necessary to understand how improvement projects can be implemented in any setting to make health care better.

As opposed to many other improvement courses — which often focus on theory or on improvement tools — this course actually takes you through a real case study, from zero. The case study is the jumping off point for the entire structure of course. You, the learner, follow a real-life improvement journey — from deciding on what to improve, all the way through making the improvement, getting the result, and every step in between — in a sequential way that allows you to see how you can improve care. That’s really it. That’s the key point behind it and the rest is detail.

Now preceding this case study, we’ve included a few theoretical segments at the beginning, so that people can begin to understand what is the underlying theory driving the science of improvement, what is the issue we’re dealing with, what are the challenges that we have, and also learn a little something about the ASSIST Project.

Remember: Rome wasn’t built in a day

People often ask me: How long have you been teaching this course? How did this course come about? This course has been a twenty-year-long journey of learning, refinement, small changes, adaptations, and revisions.

In 1996, I was a committee member of the European Forum on Quality Improvement in Health Care (what later became the International Forum on Quality and Safety in Healthcare). We were preparing for the 2nd European Forum, which was going to be convened in Paris.

It’s been a 20-year history of gradual evolution and refinement of this of course.

In discussions with colleagues in planning for the Forum, I realized that a lot of the improvement courses that existed at that time (and this is still the case) were either on the theory of improvement or the tools of improvement. What I felt was lacking was a course where somebody could walk through the improvement journey and get a feel for what it’s actually like to conduct an improvement. So, for the second European Forum, I put together a course about reducing waiting times based on a project I had done in Gaza. I used the actual data and information from the project to set up a step-by-step sequence of how you conduct an improvement project to reduce waiting times. It was a big success and I ran it several times in the years after — for the Forum, internally, and in other places.

Then, in 1998 I was running this course in Russia, under the QAP II project at the time, when it struck me that improvement had evolved to where we were no longer working on things like waiting times — we were working on clinical problems. I started to think about how we could make this more applicable to our work. 

I thought, what work do we have that lends itself to this sort of thing? Finally, I took one of our case studies — one of our actual improvement projects under the QAP III Project — and I designed the course around our efforts improving active management of the third stage of labor (AMTSL) in Niger.

Capturing every stage of the journey

It was in this iteration of the course that we designed the curriculum to walk you through all stages of an improvement intervention. What are you trying to accomplish? How will you measure it? How do you create a flowchart?

What are some of the changes you are going to make? How do you integrate clinical improvement and process redesign? How do you redraw the flowchart afterwards? How do you monitor the results on a time series chart? 

Basically, each one of those is a step in an improvement journey; taking you over a several-month project within a day. You’re covering the whole thing.

After that, I developed and ran that course with a number of different cases: one on HIV/AIDS, another on ventilator-associated pneumonia, a nutrition and counseling one. All of them went through multiple iterations. After I ran each course, I improved it, then ran it again, then made more improvements…

And then, I looked at this same course and said, “Now, how do I change this for leaders?” These are the professionals who aren’t necessarily improving care, but need to support teams that are improving care. For some of the case studies, we had two courses — one for the quality improvement (QI) team members and one for the leaders who need to support their QI team members. We had all of these different variations of the course.

So, that’s the history of this. We started in 1996; we are now in 2017. It’s been a 20-year history of gradual evolution and refinement of this course.

A new era dawns

For everyone who knows me, you know I’m nostalgic: I like old things. But we reached a point where demand for the course outstripped what I could teach on my own or what my colleagues could teach in person. The eLearning course emerged from this desire: How do we share our experience teaching (and conducting) quality improvement interventions with others who want these skills?

When I run the course in person, I tend to do it over three half-day sessions, but it is a lot of information and a lot of brain dump on those new to improvement. With the interactive virtual course, learners can take the course on their own pace, on their own time, and repeat sections as many times as needed. You can take it online, download the materials and take it offline; you can use the participant and facilitator guides to supplement your learning. Use the virtual course to run an in-person training yourself! Do whatever you want to do with it.

That, for me, is the beauty of the eLearning course. It gives you the freedom to use and adapt this curriculum in the way that works best for you.

So, welcome to the newest chapter in an old, old story.


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