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Exemplary Care and Learning Sites: A Model for Achieving Continual Improvement in Care and Learning in the Clinical
Linda A Headrick1, Greg Ogrinc, Kimberly G Hoffman
1L.A. Headrick is senior associate dean for education and Helen Mae Spiese Professor in Medicine, University of Missouri School of Medicine, Columbia, Missouri. G. Ogrinc is senior associate dean for medical education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, and associate chief of staff for education, White River Junction VA Hospital, White River Junction, Vermont. K.G. Hoffman is associate dean for curriculum and assessment, School of Medicine, and associate professor, Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, Missouri. K.M. Stevenson is clinical assistant professor, School of Physical Therapy, University of Saskatchewan, Saskatoon, Saskatchewan, Canada, and adjunct lecturer and PhD candidate, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden. M. Shalaby was internal medicine residency program director, Lehigh Valley Health Network, Allentown, Pennsylvania, at the time of writing. He is now program director of the internal medicine-primary care residency and associate professor of clinical medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania. A.S. Beard is internal medicine hospitalist, Minneapolis VA Healthcare System, and assistant professor of medicine, University of Minnesota Medical School, Minneapolis, Minnesota. K.E. Thörne is child and youth psychiatrist and head of clinical education, Region Jönköping County, Jönköping, Sweden. She is also a PhD candidate in medical education, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, and Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden. M.T. Coleman is Marie Lahasky Chair and Professor, Department of Family Medicine, and teaching scholar, Louisiana State University Health Sciences Center, New Orleans, Louisiana. K.D. Baum is associate chair for
Problem:
Current models of health care quality improvement do not explicitly describe the role of health professions education. The authors propose the Exemplary Care and Learning Site (ECLS) model as an approach to achieving continual improvement in care and learning in the clinical setting.
Approach:
From 2008-2012, an iterative, interactive process was used to develop the ECLS model and its core elements--patients and families informing process changes; trainees engaging both in care and the improvement of care; leaders knowing, valuing, and practicing improvement; data transforming into useful information; and health professionals competently engaging both in care improvement and teaching about care improvement. In 2012-2013, a three-part feasibility test of the model, including a site self-assessment, an independent review of each site's ratings, and implementation case stories, was conducted at six clinical teaching sites (in the United States and Sweden).
Outcomes:
Site leaders reported the ECLS model provided a systematic approach toward improving patient (and population) outcomes, system performance, and professional development. Most sites found it challenging to incorporate the patients and families element. The trainee element was strong at four sites. The leadership and data elements were self-assessed as the most fully developed. The health professionals element exhibited the greatest variability across sites.
Next Steps:
The next test of the model should be prospective, linked to clinical and educational outcomes, to evaluate whether it helps care delivery teams, educators, and patients and families take action to achieve better patient (and population) outcomes, system performance, and professional development.
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