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Phase I Impact Factors
ОглавлениеWhat Phase I factors contributed to QSEN’s eventual influence? First, the underlying issue was a major public concern based on documented quality and safety problems (Kohn, Corrigan, and Donaldson, 2000). The need for changes in health professions education had been made, strongly and clearly, by respected leaders (IOM, 2003), but the knowledge of the implications of this work by health professional faculties was minimal at best. We needed QSEN thought leaders who had the requisite expertise in the competencies (patient‐centered care, teamwork and collaboration, evidence‐based practice, quality improvement, safety, and informatics) and teaching pedagogies (clinical, classroom, skills/simulation laboratory, and interprofessional education). But we also needed leaders who had bridged the academic and practice worlds through personal commitments and experiences working to improve the health of populations, health care system performance, and professional development. We needed people who could tell stories about the knowledge, skills, and attitudes required to fundamentally improve health and health care.
QSEN faculty and advisory board members brought these attributes to the work and deepened their learning in dialogue with each other as the work progressed. For starters, QSEN’s spread was derived from the importance of the problem and the unique expertise of QSEN leaders, whose collective experiences with improving both patient care and health professions education provided a strong platform for new ways of thinking about quality and safety education in nursing.
Second, eight faculty and advisory board members were members of the DSS community, and thus they were familiar with how to use group processes to generate new ideas. These QSEN leaders had witnessed change in the world of health care improvement and health professions education as a result of DSS community work, and were experienced at “thinking big” in attempts to improve health, health care, and health professions education. We were also imbued with the philosophy of community work expressed annually by Dr. Batalden, namely:
Practice hospitality that invites open sharing. Help keep the space open for exploration.
Practice your own trustworthiness and enhance the trustworthiness of the commons.
Share generously, but no stealing. Protect each other’s futures.
Practice listening and dialogue, more than telling and discussion.
Reflect into the gift of silence when it occurs, rather than rushing to obliterate it with words.
Table 3.1 QSEN Faculty, Staff, and Advisory Board Members
| Project Team | Faculty—Competency Experts | Faculty—Pedagogy Experts | Advisory Board Members |
|---|---|---|---|
| Project Investigators | Jane Barnsteiner1 University of Pennsylvania | Carol Durham UNC‐Chapel Hill | Paul Batalden1 , 2 IHI, ACGME |
| Linda Cronenwett1 , 2 UNC‐Chapel Hill | |||
| Lisa Day UC‐San Francisco | Geraldine (Polly) Bednash AACN Executive Director | ||
| Gwen Sherwood UNC‐Chapel Hill | Joanne Disch1 University of Minnesota | ||
| Pamela Ironside1 , 2 Indiana University | |||
| Librarian | |||
| Jean Blackwell | Jean Johnson George Washington University | ||
| Shirley Moore1 Case Western Reserve University | Karen Drenkard AONE | ||
| Project Managers | |||
| Elaine Smith | |||
| Assistant: C. Meyers | Pamela Mitchell1 , 3 University of Washington | Leslie Hall1 RWJF ACT Initiative; IHI Health Professions Education Collaborative | |
| Denise Hirst4 | |||
| Assistant: D. O’Neal | |||
| Web Manager | Dori Taylor Sullivan | ||
| Steve Segedy4 | Sacred Heart University, Fairfield, CT, and Duke University | ||
| Mary (Polly) Johnson NCSBN Vice President | |||
| Deborah Ward4 University of Washington and UC‐Davis | |||
| MaryJoan Ladden Director, RWJF ACT Initiative | |||
| Judith Warren University of Kansas | |||
| Audrey Nelson PI, ANA Safe Patient Handling Initiative | |||
| Joanne Pohl4 NONPF President | |||
| Elaine Tagliareni NLN President Elect |
1 Dartmouth Summer Symposium community.
2 IHI board members.
3 Phase I only.
4 Phase II only.
AACN, American Association of Colleges of Nursing; ACGME, Accreditation Council for Graduate Medical Education; ACT, Achieving Competence Today; ANA, American Nurses Association; AONE, Association of Nurse Executives; IHI, Institute for Health Care Improvement; NCSBN, National Council of State Boards of Nursing; NLN, National League for Nursing; NONPF, National Organization of Nurse Practitioner Faculties; PI, principal investigator; RWJF, Robert Wood Johnson Foundation; UC, University of California; UNC, University of North Carolina;
QSEN leaders easily adopted DSS values and methods for generating ideas and making decisions. As a result, people from multiple professional organizations were able to take QSEN work, yet unpublished, into organizational deliberations regarding standards for licensure, accreditation, and certification. They invited QSEN faculty to provide special sessions at annual meetings to build will for proposed changes. They provided in‐kind support for announcements of QSEN activities and products. They envisioned the parts of the work that could best be done by their own organizations. Beyond anyone’s hopes or expectations, the work was spread, as it was envisioned, as a product of the profession itself.
Another impact factor was the QSEN decision to forge a path slightly different from medicine’s response to the IOM (2003) report. Physician leaders who had worked to create alignment on descriptions of system‐level competencies for undergraduate, graduate, and continuing medical education chose not to outline learning objectives for the competencies, believing that being overly prescriptive would lessen their ability to attract faculty to the goal of improving quality and safety education. With hundreds of community college, diploma, and university‐based nursing education programs, and with the need to develop thousands of nursing faculty who taught in classroom, clinical, and simulation/skills laboratory teaching roles, QSEN leaders decided we could not assume everyone would be attracted, willing, and able to independently invent their own objectives and teaching strategies. In fact, QSEN’s explicit goal was to make it as easy as possible for nursing faculty to envision their roles in supporting quality and safety education.
As we embarked on the iterative work to outline knowledge, skills, and attitudes (KSA) objectives for each of the six QSEN competencies, we completed an initial assessment of undergraduate program leader views of how well nursing was doing currently in each domain. As reported by Smith et al. (2007), when QSEN competency definitions were the sole reference point, survey respondents from 195 schools reported that they were already teaching to these competencies, albeit with room for some improvement, and that students were generally leaving their programs having developed competencies in patient‐centered care, teamwork and collaboration, evidence‐based practice, quality improvement, safety, and informatics.
QSEN leaders clearly needed to outline the gap in professional development they knew existed. Collectively, the KSAs provided a template against which schools could identify gaps between current curricular content and the desired future. The intensive group work to define learning objectives, therefore, turned out to be an essential element in the process of building the will to change.
