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Doing better, together: The intersection between quality improvement and interprofessional collaborative practice in health professions education
Jönköping University, School of Health and Welfare, The Jönköping Academy for Improvement of Health and Welfare.ORCID iD: 0000-0003-2135-6762
2024 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis investigated the intersection of quality improvement (QI) and interprofessional collaborative practice (ICP) in the context of health professions education. The overall aim of the thesis was to explore the potential synergies between QI education and ICP education and to develop a framework that supports a system’s approach to QI and ICP integration for health professional learners’ education.

Using a convergent parallel mixed methods approach, where the results of all the individual studies are synthesized in interpretation, the thesis is made up of one quantitative intervention study and three qualitative case studies. The intervention study analysed changes to self-reflection about interprofessional teams before and after participating in a QI activity. The qualitative studies used a mix of one-on-one interviews, stimulated recall interviews, document analysis, and a focus group.

The first study found significant increases in reflection scores in a majority of the 16 items measured, indicating that a quality improvement-focused learning activity in an ICP setting can support development of ICP related knowledge, attitudes, and beliefs. The second and third study reported on faculty perspectives about what should be taught in an integrated QI-ICP curriculum, in the form of competency domains, and how it should be taught in terms of curriculum design. The fourth study offered key insights into how program transformation in higher education can be better enabled in practice, using the integration of a QI-ICP curriculum as the case, while also suggesting refinements to a complex adaptive systems-based change management framework.

The findings of the four studies were synthesized through the lens of micro-meso-macro system perspectives and points of convergence and divergence were noted in order to develop a more complete picture of QI-ICP integration in health professions education. The results include a framework of design principles to support faculty to integrate QI and ICP education, whether working on curricular innovations in their own classroom, working on an interconnected program of learning, or attempting curricular transformation at the scale of the macrosystem.

Place, publisher, year, edition, pages
Jönköping: Jönköping University, School of Health and Welfare , 2024. , p. 97
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 138
Keywords [en]
quality improvement, interprofessional collaborative practice, health professions education, complex adaptive systems, curricular change
National Category
Health Sciences Educational Sciences
Identifiers
URN: urn:nbn:se:hj:diva-65068ISBN: 978-91-88669-51-3 (print)ISBN: 978-91-88669-52-0 (electronic)OAI: oai:DiVA.org:hj-65068DiVA, id: diva2:1872799
Public defence
2024-08-23, Forum Humanum, School of Health and Welfare, Jönköping, 13:00 (English)
Opponent
Supervisors
Available from: 2024-06-19 Created: 2024-06-18 Last updated: 2025-10-13Bibliographically approved
List of papers
1. A quality improvement activity to promote interprofessional collaboration among health professions students
Open this publication in new window or tab >>A quality improvement activity to promote interprofessional collaboration among health professions students
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2009 (English)In: American Journal of Pharmaceutical Education, ISSN 0002-9459, E-ISSN 1553-6467, Vol. 73, no 4, p. 1-7, article id 64Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To develop and evaluate a classroom-based curriculum designed to promote interprofessional competencies by having undergraduate students from various health professions work together on system-based problems using quality improvement (QI) methods and tools to improve patient-centered care.

DESIGN: Students from 4 health care programs (nursing, nutrition, pharmacy, and physical therapy) participated in an interprofessional QI activity. In groups of 6 or 7, students completed pre-intervention and post-intervention reflection tools on attitudes relating to interprofessio nal teams, and a tool designed to evaluate group process.

ASSESSMENT: One hundred thirty-four students (76.6%) completed both self-reflection instruments, and 132 (74.2%) completed the post-course group evaluation instrument. Although already high prior to the activity, students' mean post-intervention reflection scores increased for 12 of 16 items. Post-intervention group evaluation scores reflected a high level of satisfaction with the experience.

CONCLUSION: Use of a quality-based case study and QI methodology were an effective approach to enhancing interprofessional experiences among students.

National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:hj:diva-28003 (URN)19657497 (PubMedID)
Available from: 2015-09-22 Created: 2015-09-22 Last updated: 2025-10-13Bibliographically approved
2. Background and foreground: Connections and distinctions when health professions faculty teach both interprofessional collaborative practice and quality improvement—A case study
Open this publication in new window or tab >>Background and foreground: Connections and distinctions when health professions faculty teach both interprofessional collaborative practice and quality improvement—A case study
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2025 (English)In: Journal of Medical Education and Curricular Development, E-ISSN 2382-1205, Vol. 12Article in journal (Refereed) Published
Abstract [en]

Objectives: Despite decades of effort, programs continue to struggle to integrate competencies related quality improvement (QI) and interprofessional collaborative practice (ICP) into health professions education. Additionally, while QI and ICP may seem intuitively linked and there exists some examples of a coordinated approach, the literature regarding competencies, including knowledge, skills, and attitudes (KSAs), is still largely focused on QI and ICP as separate fields of knowledge and practice. This study explored distinctions and connections between quality improvement (QI) and interprofessional collaborative practice (ICP) competency domains in health professions education.

Methods: The authors used a qualitative case study approach with an instrumental case, that is, the University of Missouri-Columbia (MU), where QI and ICP were intentionally integrated as part of core curricula in health professional schools and programs. Eleven faculty members from medicine, nursing, pharmacy, and health care administration participated in interviews exploring their teaching choices in either classroom or clinical settings.

Results: Study participants defined the goal of teaching QI and ICP as enabling learners to deliver safe and patient-centered care and described the knowledge and skills required for QI and the attitudes and skills required for ICP. Furthermore, they described the relationship between QI and ICP as one mediated by systems thinking, where ICP is backgrounded as a critical pre-requisite and QI is foregrounded as a vector for developing interprofessional competencies.

Conclusions: The MU case elucidates the potential synergies that occur when faculty address quality improvement and interprofessional collaborative practice competencies with an integrated approach that leverages connections, while also respecting distinctions. For health professions education programs looking to improve the effectiveness and efficiency of their curricular approach to these fields, it may be fruitful to consider ICP as background and QI as foreground, remembering that without each other, ICP risks losing meaning and QI risks losing impact.

Place, publisher, year, edition, pages
Sage Publications, 2025
Keywords
education, health professions, interprofessional collaborative practice, quality
National Category
Health Sciences Educational Sciences
Identifiers
urn:nbn:se:hj:diva-65060 (URN)10.1177/23821205251318925 (DOI)001417330300001 ()39936094 (PubMedID)GOA;intsam;958339 (Local ID)GOA;intsam;958339 (Archive number)GOA;intsam;958339 (OAI)
Note

Included in doctoral thesis in pre-print form.

Available from: 2024-06-18 Created: 2024-06-18 Last updated: 2025-10-13Bibliographically approved
3. From Theory to Practice: The Enacted Curriculum of a Successful Master's Program in Quality Improvement and Leadership
Open this publication in new window or tab >>From Theory to Practice: The Enacted Curriculum of a Successful Master's Program in Quality Improvement and Leadership
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2023 (English)In: Journal of Continuing Education in the Health Professions, ISSN 0894-1912, E-ISSN 1554-558X, Vol. 43, no 4, p. 234-240Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Blended learning has taken on new prominence in the fields of higher and continuing education, especially as programs have shifted in response to teaching in a global pandemic. The faculty at the Jönköping Academy's Masters in Quality Improvement and Leadership program has been offering a blended learning curriculum, based on four core design principles, since 2009. We studied key features of the enacted curriculum to understand conditions that can support an effective blended learning model. METHODS: We used a case study approach underpinned by interactive research. Document analysis, a focus group, individual interviews, and stimulated recall interviews were used for data collection. Themes were identified through qualitative content analysis and data reduction, data display, and conclusion drawing. RESULTS: We grouped data into six emergent themes that clarify the enacted curriculum of an established Master's program: focusing on a common purpose, developing technical and relational knowledge and skills, linking theory and practice in the workplace, leveraging collaboration for mutual benefit, concentrating on leadership and coaching, and applying a blended and interprofessional learning model. CONCLUSION: Educators faced with increased demands to be flexible and to offer opportunities for distance education can learn from this case example of effective teaching of quality improvement and leadership in a blended format.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2023
Keywords
Curriculum, Faculty, Focus Groups, Humans, Leadership, Quality Improvement, human, information processing, total quality management, university
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Pedagogy
Identifiers
urn:nbn:se:hj:diva-63031 (URN)10.1097/CEH.0000000000000463 (DOI)001109893800006 ()37092547 (PubMedID)2-s2.0-85178497214 (Scopus ID)HOA;intsam;920155 (Local ID)HOA;intsam;920155 (Archive number)HOA;intsam;920155 (OAI)
Available from: 2023-12-11 Created: 2023-12-11 Last updated: 2025-10-13Bibliographically approved
4. A Complex Adaptive Systems Approach to Health Professions Education Transformation: The Case of the University of Missouri-Columbia School of Medicine and an Integrated Quality Improvement-Interprofessional Collaborative Practice Curriculum
Open this publication in new window or tab >>A Complex Adaptive Systems Approach to Health Professions Education Transformation: The Case of the University of Missouri-Columbia School of Medicine and an Integrated Quality Improvement-Interprofessional Collaborative Practice Curriculum
2025 (English)In: Journal of Medical Education and Curricular Development, ISSN 2382-1205, Vol. 12, article id 23821205251315624Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES

In 2003, the University of Missouri-Columbia School of Medicine (MU SOM) initiated an integrated quality improvement-interprofessional collaborative practice (QI-ICP) curriculum as part of a larger curriculum renewal process. While exploring a different case study focused on the content of the curriculum, investigators became intrigued by MU SOM's approach to change, specifically, how complex adaptive systems (CAS) thinking may have supported sustained transformational change in curriculum across multiple health professions programs. The primary aim of this study was to elucidate the aspects of MU's experience with transformation that were grounded in CAS. A secondary aim was to explore the usefulness of a CAS-based management framework for organizational transformation using the case of curricular transformation in health professions education at MU.

METHODS

Data collection involved interviews, with twelve faculty from a variety of programs, and document analysis, including previously published papers and gray literature (websites, organizational charts and planning documents, and faculty development materials).

RESULTS

Using abductive analysis, we found that leadership in the health professions programs at MU, informed by earlier learning about organizational sensemaking and CAS theory, addressed all 9 of the characteristics of CAS presented in the initial framework. Additionally, systematic combining revealed the need to adjust the framework to ensure applicability to health professions education. The analysis of MU's experience also offered key insights into how that transformation happened in practice. The CAS framework adjustments make explicit the importance of common purpose and the concept of leadership as an emergent event and make it easier to apply the framework to a broader set of organizational contexts, including health professions education.

CONCLUSION

The use of the adjusted framework, informed by insights from this specific case, may help health professions education programs evaluate past change efforts or plan for future change.

Place, publisher, year, edition, pages
Sage Publications, 2025
Keywords
complex adaptive systems, medical education, quality improvement, interprofessional collaborative practice, transformational change
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Pedagogy
Identifiers
urn:nbn:se:hj:diva-67405 (URN)10.1177/23821205251315624 (DOI)001429330800001 ()40027954 (PubMedID)GOA;intsam;1005382 (Local ID)GOA;intsam;1005382 (Archive number)GOA;intsam;1005382 (OAI)
Funder
Futurum - Academy for Health and Care, Jönköping County Council, Sweden
Note

Included in doctoral thesis in manuscript form.

Available from: 2025-03-06 Created: 2025-03-06 Last updated: 2025-10-13Bibliographically approved

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Stevenson, Katherine

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