Mixing Disciplines And The IHI Open School At Case Western

December 2013

There’s a unique rule in associate professor Mary Dolansky’s interdisciplinary course, “The Continual Improvement of Healthcare,” at Case Western University in Cleveland. Just one little thing that all the medical students, nursing students, public health students, nutrition students, business students, and law students need to keep in their minds throughout the semester:

No abbreviations!

“There are too many,” Dolansky, PhD, RN, says with a laugh.

Without “EMS” (emergency medical service), “NICU” (neonatal intensive care unit), and “JNOV” (judgment notwithstanding verdict), the course has become an engaging educational opportunity for students at the school. About 20-25 students join the class, which now includes several IHI Open School modules, when it’s offered every fall.

“The different perspectives that people have is really amazing,” says Dolansky, who has taught the course since 2004. “And teamwork plays such a large role in improvement.”

Dolansky took the course reins from three colleagues — Duncan Neuhauser, PhD; Linda Headrick, MD, MS; and Shirley Moore, PhD, RN, FAAN — who created “The Continual Improvement in Healthcare” in the mid-1990s.

“They knew that interprofessional collaboration was key,” Dolansky says. “They felt it was important to offer a course where everyone was invited. And they thought it was important to have an experiential component.”

That experiential component still exists and serves as the cornerstone of the course, which meets from 5:30 PM – 8 PM once a week in order to satisfy a variety of discipline-specific schedules. Dolansky separates the students into groups of three or four to work on quality improvement projects throughout the semester. Sponsors, who are usually from the quality center at the University Hospitals of Cleveland, select the projects and serve as mentors during the 15-week semester.

“The hospital sponsors find the input from those outside of health care very refreshing,” Dolansky says.

The teams have tackled — and continue to tackle — several different projects, hoping to improve, for example, transitions of care, medication reconciliation, emergency department flow, and wait times in the clinic. Because the projects originate from the hospital, they often continue on long after the students close out the semester.

“We aim for all of the student groups to get to the point of testing, to do some PDSA cycles,” Dolansky says.

That’s where the IHI Open School courses are integrated. Dolansky assigns the six quality improvement courses within the Basic Certificate — QI 101: Fundamentals of Improvement to QI 106: Level 100 Tools — at different stages during the semester. She weaves the modules between the four major assignments, which include literature reviews, fishbone diagrams, data plans, and interventions.

“Students like them a lot,” Dolansky says of the IHI modules. “And I like them because when students provide the certificates of completion (from each course), you know they did it. You’re never quite sure when you assign reading.”

The project teams, which include students from all different disciplines, don’t always see eye to eye, Dolansky says.

“That’s when we employ team tools,” she adds. “We talk about mental models and the students complete the Team Learning Inventory, a team assessment tool developed by Tony Lingham, PhD, of the Weatherhead School of Management. After the assessment, we coach the teams and help them to improve their team performance.”

The skills students’ learn in the course — which Dolansky admits she uses with her own children — are transferable beyond the classroom and in every profession.

“That’s the beauty of this content,” Dolansky says. “It can be used in every facet of life. Even if these students don’t go into health care, they can use the principles everywhere. I know they have made me more aware as a person.”

Dolansky even applies some of the thinking to the course itself, asking students to fill out weekly “minute” papers, or surveys, after each class. Students share feedback about what went well, what didn’t go well, and what improvements can be made. They also rate the class on a scale from 0–5.

“You’d think after 10 years that all the feedback would be good, but students always have ideas for improvement,” Dolansky says. “That’s what the course is all about. We have to agree that we can always do things better.”

Editor’s Note: To learn more and explore the resources from the course, “The Continual Improvement of Healthcare,” click here.

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