Engaging Residents in Quality Improvement and Patient Safety: A Positive Deviance Study

Abstract

Background: Quality Improvement and Patient Safety (QI/PS) curricula are vital components of graduate medical education. However, variability in the depth and intensity of this curricula persists nationally. Existing literature places emphasis on reporting the clinical and educational outcomes of QI/PS curricula, but there is limited investigation of the learner experience. This study aims to utilize the positive deviance approach to characterize the lived experiences of QI/PS champions in order to draw broader conclusions regarding best practices and future directions for resident engagement in QI/PS initiatives. Methods: Semi-structured interviews were conducted with 17 QI/PS champions, 9 residents and 8 faculty, from 6 institutions in the ACGME Pursuing Excellence Initiative, Innovator and Leader cohorts. Purposive and snowball sampling was utilized with GME leadership acting as key informants. Qualitative content analysis was conducted iteratively to analyze transcripts and generate emerging themes regarding resident and faculty motivations for participation in QI/PS and future opportunities for engagement. Results: Analysis revealed that though barriers to QI/PS education appeared to be comparable among participating institutions, an alignment of personal and professional values with the work of QI/PS led learners to a path of becoming QI/PS champions. A three-phase process of learner transformation into a QI/PS champion emerged, initiated by a spark that ignited interest, followed by a continued pursuit of QI/PS experiences, ultimately resulting in a new professional identity for learners that incorporated QI/PS as an essential role for a physician. Interviews also revealed a secondary theme addressing opportunities for decreasing barriers to entry and increasing resident engagement in this topic. Conclusions: QI/PS champions emerge when learners detect a concordance between the purpose of QI/PS initiatives and the values that inform their professional identity as a physician. Future curricula that address this topic should place a stronger emphasis on helping learners appreciate the personal and professional relevance of QI/PS initiatives on their role as a physician.