The Quality Improvement Director position is one of the most challenging leadership positions in a small rural or Critical Access hospital. Besides being the “in-house” expert on all internal and external requirements for quality data reporting and state or accreditation compliance issues, often the QI Director is tasked with other duties like: infection control, risk management, employee and patient safety, and sometimes patient care hours. Even in hospitals that are affiliated with larger systems, the QI Director is often isolated and left to their own way to navigate through prioritizing and successfully meeting these challenges. Newly hired, experienced QI Directors have some career experience to draw on, but novices to the Quality Director position are at high risk for frustration and failure without resources like networking and collaboration. Additionally, novice QI Directors are at a disadvantage, since education to develop quality leadership skills is costly, takes time away from the facility, and novices are unaware that they need additional resources until they are in crisis. 

Wisconsin’s Quality Residency Program is structured around in-person learning modules, where the novice quality leader is highly engaged in an interactive, reflective, and enriched learning environment. The modules are held every other month and are designed with adult learning principles: basic quality theory, with content delivered by expert presenters; hands-on experience with tools for data-driven decision making; and building a network of sharing and support for professional development and hot topics. Between the modules, participants will be supported by an email distribution list, and facilitated coaching calls.

Resources Used & Implementation

RWHC, along with strategic partners; Wisconsin Hospital Association, Bellin Health, and Qualitas Consulting, have developed and launched the “Wisconsin Quality Residency Program”. The concept was first addressed in a submission for federal grant to create a "pilot program". While the submission did not receive grant funding, the parties developed the training curricula, and set a "go live" date for Spring of 2014.

Modeled after the existing and extremely successful Wisconsin Nurse Residency Program, the Quality Residency Program will engage new and novice QI Directors in a two-year track of essential QI learning modules, establishing peer and mentoring relationships, and developing effective management and leadership strategies.

Lessons Learned

Increased quality and safety in patient care benefits the whole community. By decreasing the incidence of healthcare-acquired conditions like blood clots, infections, and injuries from falls that happen in hospitals, we maximize the health of the patient and minimize the unneeded utilization of post-acute care providers. When the continuum of care is utilized appropriately, costs are contained and systems can work more effectively. An effective Quality Improvement leader can work to make safe and effective patient care “everyone’s job”, and enlist the participation of all providers and patients to engage in a healthcare delivery system that is timely, equitable, and responsive.

But these traits are not inherent in the current healthcare system, and the skill needed to promote quality and safety is not intuitive. The Quality Residency Program will incorporate education to address both the technical skills needed to monitor quality and the networking needed to help participants share and “shamelessly steal” successful ideas that others have used in their hospitals. While new “services” may not result as a product of this sharing, new approaches and networks of collaboration would be anticipated.

Results

The first class was held in the spring of 2014, with 30 quality staff participating. The Quality Residency Program, well-planned and thoroughly documented, will be replicable in other settings – whether in rural health hospital networks, state associations, hospital systems, or even in integrated care networks. We intend that the model be used to “raise all boats” by establishing basic competency training in QI methods, leadership and management skills, and networking support.

Contact

For more information, contact
Dave Johnson
Director Member Relations & Business Development, RWHC
608-643-2343