ACT Project: University of Pennsylvania Health System, Philadelphia, 2003-06

Partnerships for Quality Education

Field of Work: Aligning the training of physicians and nurse practitioners with the demands of 21st-century clinical practice.

Problem Synopsis: In the 1990s, managed care became one of the dominant forces in health care. Physicians and nurse practitioners (NP's) were expected to know how to manage patients' health, often within a fixed budget. Although care was increasingly taking place in outpatient settings, physicians continued to receive most of their training in hospitals rather than in ambulatory care centers. They also received little training in preventive care, or in interprofessional collaboration.

The University of Pennsylvania Health System had experienced significant financial difficulties. Health System leaders were seeking ways to become more efficient. Each department in the health system had yearly quality improvement, safety and cost savings goals.

Synopsis of the Work: Partnerships for Quality Education (PQE) (April 1999 through January 2009), was initially funded by the Pew Charitable Trusts (during which time it focused on physicians only) and then by RWJF (which expanded it to include NP's). The program sought to improve a core set of skills in physicians and nurse practitioners, including interprofessional collaboration, chronic illness management, systems-based care and practice-based quality.

The University of Pennsylvania participated in the Achieving Competence Today (ACT) component of PQE.

Lessons Learned:

  • Buy-in from your institution's executive leadership and its residency directors and nursing leadership is essential to gaining interest and dedicated time for the learners.
  • Organize ACT teams and the ACT quality improvement projects as early in the academic year as possible.
  • It is essential that ACT leaders address the difficulties of the potential of mismatched schedules for nurses and residents.
  • Consider having ACT learners travel to other health systems that are participating in ACT.
  • Consider creating a standing appointment of an ACT learner on one or more quality committees at your institution.

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