The Expert:

Peter Lachman

Dr Peter Lachman is the CEO of ISQua and lead international faculty at RCPI in Dublin where he co-directs the Leadership and Quality programme to develop clinical leaders in quality improvement. He is co-founder and chairperson of the Paediatric International Patient Safety and Quality Community. Previously he was deputy medical director at Great Ormond Street Hospital in London, with the lead for patient safety. Dr Lachman was the national clinical lead for SAFE, an RCPCH programme funded by the Health Foundation.

Their View:

Paul Batalden tells us that everyone in healthcare has two jobs: to do their work and to improve it.[1] We train young healthcare professionals to do the job – but do we train them to be improvers?

The challenge

Despite increased awareness of the need to prevent patient harm, today’s college curricula for medicine are still the same as they were in the 1990s. They cover the medical and surgical sub-specialties, but not the fundamentals of patient safety such as human factors.  We need to change the way we train healthcare professionals.

However, change can be difficult. It requires an understanding of where power lies in medical education. In medical training, power lies with established doctors and medical school professors, many of whom are unsupportive of multidisciplinary teamwork and patient-centred care. In contrast, quality improvement is still on the fringes of power. Hierarchy and tradition are also factors. Students are trained using an apprenticeship model which reproduces the traditional silos and often dysfunctional teamwork that today’s consultants learned from their own teachers.

Meeting the needs of trainees

To break this cycle and train the next generation of healthcare professionals to be quality improvers, we need to ask students what matters to them and change both the process and the structure of medical training to meet their needs. Students want quality improvement to be properly coordinated into their training to empower them to make change as practising healthcare professionals. To enable them to do this, we need to move away from subject-based training to a greater emphasis on training for interdisciplinary teamwork and quality improvement.

The mantra of quality improvement is ‘the right care, first time and every time.’ Training for quality improvement demands:

  • new ways of thinking to solve problems
  • a change in our culture, language and the way behave and teach
  • active changes to adopt new ways to solve challenges.

Furthermore, we need to redefine professionalism. This means moving away from the idea of professional autonomy to understanding that everyone is important, and away from the mindset of doctors as ‘master craftsmen’ to seeing everyone as ‘equivalent actors’.

Sklar and Lee argue that high quality care should drive medical education.[2] The objective of medical education should be to deliver safe, timely, effective and efficient care that is equitable and patient-centred. This requires a rounded education that develops skills in subjects as diverse as evidence-based medicine, process mapping, communication skills, systems engineering, economics, statistics, religion, justice, philosophy, psychology, anatomy, epidemiology and public health. Much of this is not taught at medical school today.

To achieve the change in medical education that we need to deliver high quality care, we need leadership. We must have a vision, and our trainees must have hope that things can be better. We must teach our trainees courage to think differently and ask questions. To do that, we need to cultivate respect for each other and for other healthcare professionals. We need to have the right skills and knowledge. Finally, within our jobs we need to have time and space to reflect on how we can improve.

By taking a fresh approach to medical education, we can create a healthcare workforce well trained to deliver safe, high-quality patient care.

Learn more about Dr Lachman’s work:

What does Mr Potato Head have to do with training healthcare staff to be quality improvers? 
At Ko Awatea, we use a Mr Potato Head activity to demonstrate the principles of teamwork and small iterative change to students of quality improvement.

[1] Batalden PB, Davidoff F. What is “quality improvement” and how can it transform healthcare? Qual Saf Health Care. 2007 Feb; 16(10): 2-3.

[2] Sklar DP, Lee R. Commentary: What if high-quality care drove medical education? A multiattribute approach. Acad Med. 2010 Sep; 85(9): 1401-4.

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