Innovation in Education: Integrating Quality & Leadership in a NP Residency Program Connie Cowley, DNP, RN, CPHQ, NE-BC Catherine Alexander, DNP, RN Brant Oliver, PhD, MS, MPH, APRN-BC

Improvement & Leadership: Critical Competencies Improvement is a required, and critical part of nursing education Leadership is necessary for improvement Little guidance on the best ways to teach

The Gap Leadership education Improvement education Taught in isolation Application versus didactic Complexity not addressed

Current State of Clinical Education Clinician Leader Improver

The Goal Clinician Improver Leader

Veteran’s Administration Nursing Academic Partnership – Graduate Education

An Integrated Approach For NP Residents Residents will build their QI competence AND personal leadership skills synergistically through leading an improvement project

Clark’s Learning Design Framework Curricular Design Clark’s Learning Design Framework Authentic Leadership Constructivist Learning Theory Deming’s SOPK

Deming’s System of Profound Knowledge

Clark’s Learning Design Framework

Systems in Healthcare Macrosystem - External Macrosystem - Internal Mesosystem Clinical Microsystem Patient-Practitioner Patient self-care

Authentic Leadership

Leadership in Systems Leader – External Macrosystem Leader – Internal Macrosystem Leader - Mesosystem Leader - Microsystem Leader - Patient Personal Improvement leader Clinician leader

Application 1 year program Session Format: Individual Coaching 8 sessions each with 4 combined sessions, 2 hours each Combined sessions 3 hours Session Format: Review/reflect, new content/info/theory, practice plan next steps Individual Coaching Pre-Work

Integration of QI & Leadership Improvement Find an opportunity Organize a team Clarify current knowledge Understand variation Select a change

Integration Leadership Improvement Foundational knowledge Find something to improve Integrate knowledge Organize a team

Foundational Knowledge Leadership Strength Finders Reflective practice Organizational culture Quality History of healthcare improvement Improvement frameworks Something else

Example Joint Session – Organize a Team Review/ reflect Status of “O” & “C” Elevator speech of Aim Discuss articles and lead group discussion Content Barriers in organizing a team, and barriers to overcome Introduction to Kotter’s Change Theory Practice Role play inviting people to the team Role play first meeting (Practice facilitation skills) Next Steps Plan the team meeting (invite, schedule, agenda, space)

Evaluation Overall Rating of Seminar Assignment Completion Leadership – 4.88 Improvement – 4.75 Assignment Completion Selecting improvement, prioritizing, aim statements, Strength Finders, Barrett’s Value Assessment Tool

Evaluation

Evaluation “Guest speakers were great” “Maybe more time for next steps” “The weekly calls are helpful” “I felt pushed and supported at the same time”

Next Time… More time for “next steps” More joint sessions Less time between QI sessions Add VA Transformational Coaching course More expert speakers More role play Journaling throughout Improve measurement plan

Future Directions Academic – Practice Partnerships Academia Practice Foundation for future competency DNP-PhD partnerships Finding faculty & harnessing experts Practice Leadership support Engage front-line staff Match the training to the task – complexity Academic – Practice Partnerships

PPP