Pediatric Quality & Safety | 2021
Quality Improvement Education in the Era of COVID-19: A Pivot Toward Virtual Education
Abstract
The COVID-19 pandemic stopped healthcare in our tracks. The pandemic thrust us into different ways of caring for and protecting patients and employees. The pandemic also exposed unacceptable disparities in the management of healthcare in both microsystems and macrosystems. Providing patient care in the context of an ongoing pandemic highlighted the dire need for adaptability, the transformation of care, and the broad adoption of quality improvement (QI) methodologies to optimize healthcare delivery and safety. There are multiple examples of organizations leveraging QI tools in the COVID-19 era.1–4 Though definitive data are not yet available, we posit that systems that could rapidly pivot how they think about and manage care and personal protective equipment were better positioned to meet this unprecedented healthcare challenge than organizations that were slower to adapt. QI education needed to pivot too. Children’s National Hospital, a free-standing, tertiary care, academic medical center in Washington, D.C., started a formalized QI educational program in 2015 by having multidisciplinary professionals attend Nationwide Children’s Hospital’s 4-month QI Essentials (QIE) didactic and experiential course in Columbus, Ohio. Based on the Institute for Healthcare Improvement’s Model for Improvement, QIE has an exemplary track record.5 We built a QI educational program within our institution called the QI Leadership Training (QuILT) Course, modeled after both of those programs and launched in 2019. QuILT incorporates in-person didactics, interactive small-group sessions, and one-on-one coaching. In addition to gaining knowledge in QI methodology, participants complete a practical component involving a QI project in their clinical or work area. This curriculum builds capability by developing a cadre of QI specialists and clinical, administrative, and executive leaders well-versed in QI throughout the organization. The first QuILT cohort had 9 participants; the second cohort started in January 2020 with 15 participants. In March 2020, the COVID-19 pandemic reached the United States. We were suddenly faced with questions about QuILT: Do we continue? If so, how? Can the course still include an experiential component? The answer was unanimous and clear: more than ever, QI education was necessary given the importance of QI methodology to enable fast, safe, and effective healthcare delivery during the uncertainty of the COVID-19 pandemic. Although keeping patients and employees safe necessitated limiting the number of individuals on the hospital campus, we persevered with synchronous QI education—virtually. The didactic component moved to a videoconferencing platform (Zoom by Zoom Video Communications, San Jose, Ca., zoom.us). To ensure participant engagement and collaboration that are crucial to QI education, we reviewed resources outlining tools for effective e-learning and virtual teams, and QuILT leaders coached every presenter in using these video conferencing capabilities, including instant messaging, polling, and break-out rooms.6,7 Throughout formal talks, presenters still had frequent check-ins with participants. Participants answered polling questions, annotated on a shared screen, and reacted to specific aspects of a presentation through instant messaging. Break-out rooms offered a structured, small-group environment that addressed specific agendas and fostered meaningful interactions, including relationship building. Before the pandemic, learners were required to complete a QI project in their clinical or work area, with step-by-step coaching from the QuILT leadership team (Table 1). There were challenges. Presenters had difficulty appreciating visual cues indicating learner reactions and understanding. Learners started the course with varying abilities Commentary