Course Descriptions – QIPS

These courses are for students registered in the MSc QIPS concentration. Space permitting, students from other concentrations may enroll, after obtaining permission from the instructor.

HAD3010H: Fundamentals of Improvement Science
HAD3020H: Quality Improvement Methods
HAD3030H: Concepts and Strategies in Patient Safety
HAD3040Y: Project Practicum
HAD3050H: Leading and Managing Change
HAD3060H: Quality Improvement in Health Systems
HAD3070H: Legal and Regulatory Environment and Risk Management
HAD3090H: LEAN Application in Healthcare (Elective)
HAD5777H: Leading and Managing Change: Building Adaptive Capacity (Elective)
HAD3025H: Teaching QI Methods (Elective)
HAD4000H: Human Factors(Elective)

HAD3010H

Course Number	HAD3010H
Course Name	Fundamentals of Improvement Science
Prerequisite	Summer project, pre-work readings, completion of on-line QI modules, work place project
Delivery Format	Modular
Semester Offered	Fall
Instructor	Ross Baker Patricia Trbovich

Description:
This will provide core improvement concepts for students in the new Masters of Science in Improvement stream. Students will have varying experience with health care improvement and patient safety and will have different professional backgrounds. The fundamentals course will provide a solid baseline for future courses; an understanding of the prerequisite knowledge base; areas of focus (key themes) for the program; an understanding of critical quality and safety issues facing health care today, an appreciation of the research elements of the program and an introduction to statistical process controls used in improvement processes. Specifically the course provides an introduction to program themes related to quality improvement skills and capacity; the rate of uptake, spread and sustainability of evidence based quality improvement ; leadership, innovation and change management skills; coordination and implementation of improvements across organization and between levels of health care.Course Content by Module:
All classes will combine didactic and small group interactive exercises, and guest lecturers will be invited to share expertise from the field for approximately one hour during most of the modules. This course will provide a framework for improvement science, and introduce key concepts that will be applied and expanded upon in subsequent courses in this master’s stream.

Objectives:

Describe the objectives and expectations of the MSc Program
Explain a conceptual framework for improvement
Apply this conceptual framework to a personal improvement plan
Appreciate structural contributors to system quality
Describe important features of measurement in improvement
Understand the role of human factors in improvement
Apply small scale testing principles to improvement projects
Analyze factors associated with successful implementation
Critically appraise improvement studies
Demonstrate skills in persuasive presentations
Integrate all of these concepts to an improvement project protocol

Evaluation:

Assignment 1	20%
Assignment 2 Peer Assessment	10%
Assignment 3	40%
Assignment 4	20%
Class Participation	10%

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HAD3020H

Course Number	HAD3020H
Course Name	Quality Improvement Methods
Prerequisite	HAD3010H
Delivery Format	Modular
Semester Offered	Fall
Instructor	Paula Blackstien-Hirsch Nava Maham Erin Spicer

Description:This course will cover concepts and methods used for quality improvement in healthcare and will build on the basics covered in the Fundamentals of Improvement Science course. Topics will include methods and tools required to design and implement a quality improvement project from start to finish. The course will begin with an organizational context for conducting quality improvement work at a micro-system level, identification of team-based enablers for successful improvement, and three key approaches/models for improvement. The course will subsequently focus on the most common methods, tools and measurement techniques used to improve healthcare delivery, and will conclude with essentials for sustaining change at a microsystem level, as well as incorporating a workshop on Experience-Based Design, a method for engaging patients in improvement work.The course structure will mirror the flow of an improvement project, beginning with initial design, and continuing through the diagnostic, solution generation, testing, measuring, and implementation phases. Students will be expected to apply the concepts introduced throughout the course to their individual improvement projects. The course is designed to provide students with the knowledge and skill necessary to plan and implement a successful quality improvement project, and to distinguish the most appropriate methods and tools to include in project design, based on the specific improvement challenges being addressed.

Objectives:

Describe the history and evolution of quality improvement science.
Critique a quality improvement project to identify the presence or absence of factors that contribute to a success, including strategies for influencing and sustaining change at the micro-system level.
Describe and apply the principles of Lean methodology and distinguish the conditions under which Lean, Six Sigma and the Model for Improvement are most applicable.
Apply basic improvement tools to a quality improvement project, and demonstrate an ability to distinguish the use of specific tools to address different types of improvement challenges.
Summarize key principles for measurement for improvement, and develop and interpret statistical methods used to display data.
Discuss and experiment with different strategies for generating innovative ideas for improvement.
Integrate fundamental principles, methods and tools for quality improvement in order to design and implement a quality improvement project.
Analyze the strengths and weaknesses of common evaluation designs for quality improvement initiatives through application of the rules of evidence to the published literature.

Evaluation:

Assignment 1	15%
Assignment 2	20%
Assignment 3	25%
Assignment 4	30%
Class Participation	10%

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HAD3030H

Course Number	HAD3030H
Course Name	Concepts and Strategies in Patient Safety
Prerequisite	n/a
Delivery Format	Modular
Semester Offered	Winter
Instructor	Kaveh Shojania Anne Matlow

Description:
Efforts to improve patient safety have thus far fallen into two different but, not mutually exclusive categories: 1) a “safety science approach”, drawing on lessons from other high risk industries to develop systems for reporting and learning from safety problems, recognizing the degree to which human errors are often facilitated by latent system problems, attention to human factors design principles affecting everything from equipment use to shift schedules and clinical environments, as well as the importance of teamwork, communication strategies, and organizational culture. 2) “evidence-based medicine approach”: as with much clinical research, this approach targets common problems (in this case, harms caused by medical care as opposed to diseases), looks for interventions to prevent such complications (e.g., prophylaxis for venous thromboembolism, bundles for preventing central-line associated infections, bar-coding to prevent medication administration errors), assesses the evidence supporting these interventions and the degree to which effective implementation strategies also exist.Beginning with a brief history of patient safety in healthcare, including high profile cases and seminal studies that launched the widespread interest in patient safety, the course will cover key concepts and examples from both of the approaches to studying and reducing patient safety problems. The course will use examples of commonly discussed patient safety practices to convey the state of the evidence supporting the practices as well as key underlying concepts. For instance, the discussion of order sets and computerized decision support will include a review of what is known about their current effectiveness, but also include human factors concepts related to optimal order set design. Similarly, the discussion of checklists will include not just the evidence supporting their benefit (e.g., in peri-operative settings) but also the importance of attending to teamwork and communication issues that support successful implementation.

Objectives:

To describe the impetus for improving safety in health care
To describe fundamental issues in human error and systems thinking related to improving patient safety
To describe lessons from other high reliability organizations, including the importance teamwork and culture
To analyse an evidence based approach to common healthcare safety problems
To describe key elements of organizations that support safer care
To analyse quantitative and qualitative measurement strategies in patient safety
To identify strategies to gather patient perspectives to expand their role in supporting effective outcomes of care
To describe and choose strategies to identify, analyze and address patient safety issues

This course will utilize some of the principles learned in Quality Improvements Methods course to illustrate patient safety issues (e.g. Analysis of Statistical Process Control charts).

Evaluation:

Assignment 1	25%
Assignment 2	25%
Assignment 3	40%
Class Participation	10%

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HAD3040Y

Course Number	HAD3040H
Course Name	Project Practicum
Prerequisite	HAD3010H and HAD3020H
Delivery Format	Modular
Semester Offered	Fall, Winter & Spring
Instructors	Patricia Trbovich Ross Baker Kaveh Shojania Christine Soong

Description:
The broad learning goal for the project course is to effectively apply principles, theories and methods of improvement science to a workplace issue. More specifically, students will learn to exercise creative and critical thinking, analyze a process, model, or situation to determine where specific interventions should be targeted, determine if an intervention is even necessary, and determine whether desired outcomes have been achieved and to assess the impact and sustainability of the interventions The project course includes the fundamentals of project management, practical skills and tools for rigorous design and implementation of a QI project, statistical methods for QI, methods for critiquing the literature related to the interventions identified and skills for writing for publication and what QI journals typically look for when reviewing articles. Students will learn to evaluate their projects from a broader perspective, assessing how an intervention fits within a broader healthcare context and how to design quality improvement projects to answer more complex questions.Instructional time will be embedded into each required course to cover the learning objectives that relate specifically to the project practicum and a session in each module will be dedicated to project development and discussion. For example the fall term courses will include instruction on literature reviews, research methods that are appropriate for quality improvement projects, discussion about research ethics, and project charters, reporting project progress to executive sponsors, development of indicators and measures. Students will meet regularly with their project mentors for guidance on their projects.

Objectives:

Identify theoretical concepts of improvement science relevant to their workplace projects;
Appraise and apply research methods that are appropriate for assessing the impact or implementation of their workplace projects;
Demonstrate effective communication skills in the presentation of the projects;
Identify the elements of an effective plan for communicating the project to the sponsoring organization;
Select and apply methods for assessing the literature related the workplace project that assesses the strength and weaknesses of the interventions proposed.
Develop the skills needed to write an article suitable for publication that describes the project

Evaluation:

Assignment 1	20%
Assignment 2	20%
Assignment 3	20%
Class Participation	10%
Final Scholarly Report	30%

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HAD3050H

Course Number	HAD3050H
Course Name	Leading and Managing Change
Prerequisite	n/a
Delivery Format	Modular
Semester Offered	Fall
Instructors	Tina Smith Christine Shea

Description:
The course will cover the knowledge domains of systems thinking and theories derived from social science, organizational theories, and psychology related to influencing transformational change and overcoming resistance to change at the clinical micro-system level and will cover a number of topic areas including:

A self-assessment of personal leadership skills;
Change management theories and application; overcoming resistance to change and modeling the environment for change;
Leadership strategies using cases and role playing exercises;
Distributive leadership for embedding and sustaining improvement and safety into practice at all levels;
Negotiation, coaching and conflict management;
Physician and other stakeholder engagement;
Strategic alignment of quality from the top and from the bottom;
Definition of knowledge translation and its application to quality improvement and safety.

Objectives, Learning Outcomes:The overall course objective is to enhance individual leadership capacities and provide leadership tools for influencing organizational effectiveness around quality improvement and patient safety at the clinical microsystem level.Upon completion of this course it is expected that students will:

Demonstrate the integration of knowledge and application of different conceptual frameworks for basic leadership, change management, systems theories, and knowledge translation theories and competencies required to improve quality and enhance patient safety at the clinicalmicrosystem level linked to organizational (meso) and system (macro) levels.
Describe their personal leadership style and explain how it relates to leading and managing change in health care at the clinical microsystem/team level.
Identify key leadership, change management (negotiation, coaching and conflict management skills) and knowledge translation strategies for creating and sustaining practice/process change and innovation, including the senior leadership practices required to support and enable microsystem level improvement.
Understand strategic alignment of the quality and safety agenda with other key organizational priorities and initiatives.
Describe various strategies for engaging physicians and other stakeholders to improve quality improvement and patient safety.
Identify the characteristics of high performing healthcare systems and judge the effectiveness of current systems in adopting and implementing these strategies

This course will utilize some of the principles learned in Quality Improvements Methods course to illustrate patient safety issues (e.g. Analysis of Statistical Process Control charts).

Evaluation:

Self Assessment (3 pages)	5%
Simulation exercise reflection and application	25%
Leadership Report template	30%
Final Paper (8-10 pages)	30%
Class Participation	10%

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HAD3060H

Course Number	HAD3060H
Course Name	Quality Improvement in Health Systems
Prerequisite	HAD3020H
Delivery Format	Modular
Semester Offered	Winter
Instructors	Ross Baker Chris Hayes

Description:
This course focuses on understanding how healthcare organizations and broader health systems create and implement strategies to improve care. The course builds upon the quality knowledge, skills and methods provided in the Leadership and Managing Change Course, the Concepts and Strategies in Patient Safety course and Fundamentals Course. In this course we shift focus from an emphasis on quality improvement and patient safety at a team or microsystem level to emphasize the key elements of organizations and broader healthcare systems needed to implement, spread and sustain improvements in turbulent health care environments. What knowledge do leaders need to support improvement? What is the role of governing boards? What benefit and how can we include patients in the design of care processes and systems? How do electronic health records help to promote quality improvement and patient safety? Case studies, guest lectures, readings, discussions and exercises will be use to identify key issues facing health care systems, strategies for addressing these issues and the factors that influence successful implantation of organizational and system-wide improvement efforts.

Objectives:

Analyze the critical skills and knowledge that leaders need to lead change in healthcare organizations
Assess the strategies leaders use to create effective quality and patient safety strategies in organizations and broader systems
Understand how organizations need to assess risk and deal with organizational failures
Identify the strategies needed for effective governance of quality and patient safety and appraise their implementation in various settings
Explain the impact that engaging patients can have on improvement strategies and assess the approaches used to engage patients in these efforts
Appraise the role of electronic health records in large scale improvement
Assess the role of quality councils, Ministries of Health and other support groups in monitoring and guiding system change
Identify the characteristics of high performing healthcare systems and judge the effectiveness of current systems in adopting and implementing these strategies

Evaluation:

Assignment 1 (6-8 pages)	20%
Assignment 2 (6-8 pages)	30%
Assignment 3 (Peer assessments)	20%
Final Paper (8-10 pages)	30%

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HAD3070H

Course Number	HAD3070H
Course Name	Legal and Regulatory Environment and Risk Management
Prerequisite	n/a
Delivery Format	Modular
Semester Offered	Winter
Instructors	Melanie DeWit C. Haines

Description:
This course will cover a number of topic areas including:

The risk management process (i.e. identification, assessment, mitigation), methods for identifying and ranking top clinical and other risks using data from a range of patient safety and risk management sources
Strategies for integrating organizational risk management, quality improvement and patient safety activities;
Methods for identifying, managing and investigating critical incidents, and for implementing and sustaining effective recommendations for improvement;
Principles and practices for disclosure of adverse events;
Relevant legislation and regulations (e.g. the public hospital act, disclosure, apology, consent and capacity, etc);
The rationale and legal protection for quality assurance activities;
The medical-legal claims process and the effect of claims on patient safety and quality;
The role of professional colleges in ensuring quality care, and potential issue related to the systems approach to patient safety and implementation of a just culture;
The role of the coroner in patient safety;
The role of accreditation in ensuring quality and in influencing organizational priority setting in patient safety and quality.
The course will include didactic pre-reading, lectures from leading experts, group discussion, and in-class simulations.

Objectives:

Identify and assess the range of clinical and non-clinical risks within a healthcare organization and apply a structured methodology to identify high priority risks requiring leadership and governance attention;
Recognize the linkage between risk management, quality improvement and patient safety functions and understand how they can be effectively integrated within an organization;
Categorize the multiple sources of risk management data (including incident reports, critical incident investigations, patient complaints, medical legal claims, M&M reviews, alerts, audits, etc) and outline strategies to obtain actionable information from data mining efforts;
Recognize the significant laws and regulations which govern healthcare quality and safety;
Understand the unique relationship between physicians and hospitals and describe the important role of credentialing of healthcare professionals in ensuring quality care;
Formulate arguments both for and against the protection of quality assurance information in healthcare;
Understand the civil litigation process and factors which may contribute to an adverse event proceeding to a medical malpractice claim;
Describe the challenges associated with identifying and managing critical incidents and outline the elements of successful investigation and follow up;
Outline the rationale for disclosure of adverse events to patients, debate the evidence regarding the effect of disclosure on medical malpractice claims, and analyze and critique disclosure skills;
Understand the mandate and activities of the coroner’s office, professional colleges, and accreditation, and debate their role in advancing healthcare quality and safety.

Evaluation:

Assignment 1 (5 pages)	20%
Assignment 2 (5 pages)	20%
Assignment 3 (5 pages)	40%
Class Presentation	10%
Class Participation	10%

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HAD3090H

Course Number	HAD3090H
Course Name	LEAN Application in Healthcare
Prerequisite	IHI Open School modules focused on Quality Improvement (QI 101 to 106) & Leadership (L 101), HAD3010H and HAD3020H
Delivery Format	Modular
Semester Offered	Fall
Instructors	Paula Blackstien-Hirsch Ron Bercaw

Description:
This course will cover lean based concepts and methods used for quality improvement in healthcare and will build on the basics of quality improvement covered in the Fundamentals of Improvement Science and Quality Improvement Methods courses, including the application of basic Lean concepts and principles. This course, focused entirely on Lean Improvement, will include methods and tools required to design, implement, and sustain Lean process improvements from start to finish. The course will begin with an overview of the fundamentals and the roots of Lean improvement and will then focus on the application of the scientific method using the A3 form and A3 thinking. Subsequently, the course will delve deeply into common Lean-based tools used to see and eliminate waste within healthcare. The course will conclude with approaches for sustaining change using visual management techniques at team and leadership levels, with a focus on key systems and tools used to support Lean Management.

Objectives:Through a combination of praxis and didactic methods, the course is designed to provide students with the knowledge and skill necessary to participate fully in local and system level Lean improvement initiatives, and to have the capability to select appropriate Lean tools to address specific type of process issues, and to lead components of a large Lean-based improvement initiative.

Evaluation:

Assignment 1	50%
Assignment 2	40%
Class Participation	10%

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HAD5777H

Course Number	HAD5777H
Course Name	Leading and Managing Change: Building Adaptive Capacity
Prerequisite	HAD3050H or HAD5731H
Delivery Format	Modular
Semester Offered	Winter
Instructors	Tina Smith Christine Shea

Description:
In this course, learners are presented with a leadership framework that focuses on building the capacity within themselves, their teams and their organizations to respond adaptively to the depth, pace and scope of change that is creating unprecedented conditions in healthcare systems today (S. Dalzo-Parks, 2005).
Based on the work of Ronald Heifetz, the framework requires a paradigm shift from viewing leadership as a role or person to seeing it as an activity – the activity of making progress on adaptive challenges; and from viewing the organization as a static entity to seeing it as an organism capable of adapting to its environment. It requires those exercising leadership to understand the dynamics of social systems, and to trust in their own and others creativity and intuition (S. Dalzo-Parks, 2005). Finally, it addresses the ethical challenges associated with leadership as critical choices must take into account the diversity of perspectives surrounding the issue, and the moral courage and resilience required to challenge assumed values i.e. the notion of a good death.
The second, in a two-part series on Leading and Managing Change, the overall goal of this course is to facilitate the building of adaptive capacity within healthcare systems by deepening the practice of developing both ourselves and others intentionally, mindfully and creatively. Through in-class discussion and small group consultation labs, participants will learn to mobilize constructive change through the development of a new and enhanced capacity to see, effectively analyze, and strategically intervene.

Objectives:

Distinguish between adaptive and technical work and explain what each requires to make progress (C4 – Analysis)
Indicate the difference between the role of authority and the exercise of leadership (C6 – Evaluation)
Perceive that there is a productive range of tension to make progress on leadership challenges (C5- Synthesis)
Identify the sources of resistance and develop strategies to manage them (C4- Analysis)
Identify the polarities within adaptive work and generate a process for managing them (C5 – Synthesis)
Display an ability to continually reflect in action (A5 – Characterization by a Value or Value Complex)
Relate the practices to current healthcare challenges (C6 – Evaluate)
Value the need to thrive while leading adaptive change (A3 – Valuing)

Evaluation:

Assignment 1	20%
Assignment 2	60%
Assignment 3	20%

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HAD3025H

Course Number	HAD3025H
Course Name	Teaching QI and Patient Safety
Prerequisite	HAD3010H and HAD3020H
Delivery Format	Modular
Semester Offered	Spring/Summer
Instructors	B. Wong Christine Shea

Description:
The main focus of this course is to help participants acquire the necessary skills to teach quality improvement and patient safety to peers and trainees in their own practice setting. Participants will develop the ability to utilize a variety of different pedagogical approaches to teach quality improvement and patient safety, including large group interactive lecturing, facilitating small group discussions, case-based learning (including re-vamped patient safety M&M rounds), use of role play/video debrief and experiential quality improvement projects. .

Objectives:

Define key educational terms used in health professions education
List the core patient safety and quality improvement competencies for all health professionals
Apply 5 different teaching methods to teach patient safety and quality improvement
Describe effective strategies to supervise others in their quality improvement work
Create an educational plan that outlines the key components of a patient safety or quality improvement curriculum

Evaluation:

Assignment 1	25%
Assignment 2	20%
Assignment 3	45%
Participation	10%

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HAD4000H-S2

Course Number	HAD4000H
Course Name	Human Factors
Prerequisite	n/a
Delivery Format	Modular
Semester Offered	Winter
Instructor	Patricia Trbovich

Description:
This course will provide the learner with a comprehensive working knowledge of Human Factors (HF) and how it relates to and affects health care safety. It focuses on key concepts and frameworks in HF research and practice and identifies how these can be applied to and tailored depending on the health care issue. This knowledge is relevant to policy makers, practicing clinicians, health care managers, and health services researchers.

Objectives:

Explain the meaning of a variety of key concepts and frameworks in HF practice and research
Describe the influence of HF on health patient safety issues
Conduct a heuristic evaluation and usability test to improve an intervention design

Evaluation:

Assignment 1	20%
Assignment 2	25%
Assignment 3	30%
Participation	10%

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