Table 1 Summary of studies
| Study characteristics | Population description | Intervention description | Outcomes | ||||||
|---|---|---|---|---|---|---|---|---|---|
| Study ID | Location | Study design | Population | Sample size | Training purpose | Intervention type | Delivery modes | Evaluation of outcomes | Outcomes achieved |
| Baernholdt-2017 [14] | United States | Mixed methods |
Interprofessional health care teams | 40 | Training interprofessional health care teams to lead QI projects using PDSA methodology | Interprofessional Quality Improvement Training Program | Seminars, online modules, bimonthly meetings, QI project work |
Participation Learner reactions to training Participants’ QI knowledge, attitudes, behaviours Patient safety outcomes |
19 out of 22 teams completed the programme Higher QI self-efficacy post-programme Program and sessions rated favourably Improvements in clinical settings |
| Baxley-2016 [15] | United States | Mixed methods | Interprofessional group of faculty | 27 | Preparing faculty to lead frontline clinical transformation | Teachers of Quality Academy Professional development program | Online, didactic, small-group, experiential learning, QI project, QI symposium |
Progress of QI initiatives Incorporation of educational modules into curriculum Production of scholarly products by participants Participants’ QI knowledge, attitudes, behaviours Patient safety outcomes Interprofessional practice |
All participants completed QI projects 70% participants engaged in design and delivery of curriculum Participants applied new knowledge and skills in educational initiatives development |
| Bonnes-2017 [16] | United States | Prospective validation study | Internal medicine residents | 143 | Educating trainees on how to successfully improve health care quality | Flipped QI curriculum | Online modules, facilitated small group discussions |
Preferences for mode of delivery Past experiences with delivery mode Completion of online modules Participants’ QI knowledge, attitudes, behaviours |
Improved perception of FC Participants of FC demonstrated improved QI knowledge compared to the control group FC associated with greater engagement in online modules |
| Gregory-2018 [17] | United States | Quantitative descriptive | Postdoctoral nurses, post-residency physicians, clinical psychologist | 54 | Training health care professionals to become leaders in QI | Veterans affairs quality scholars curriculum | Web-based curriculum delivered in real time |
Participants’ QI knowledge, attitudes, behaviours Transfer of training Learner reactions to training |
Learners satisfied with training Improvements in QI knowledge, attitudes, behaviours Significant improvement in affective transfer but no significant change in cognitive or skill-based transfer |
| Hafford-Letchfield-2018 [18] | United Kingdom | Mixed methods | Social workers, midwives, community nurses, occupational therapists, dieticians, general and mental health nurses | 62 | Using digital storytelling method to encourage collaboration for identifying and developing plans for service improvements | Service development and quality improvement module | Digital storytelling pedagogy with online activities and half-day workshops taught face-to-face |
Developing digital story Developing action plan to address selected issue Writing improvement plan Experience with delivery mode Patient safety outcomes |
Levelling effect in interprofessional collaboration Programme content should focus on communicating service user/patient needs Virtual learning pedagogies encourage co-construction of shared solutions across disciplines Nearly all students created innovative and informative digital stories with genuine practical utility |
| Hargreaves-2017 [19] | United States | Mixed methods | Primary care, public health, and community leaders and project managers, faculty, project staff | 11 teams | Sharing and spreading, evidence-based QI practices to prevent and treat obesity | National Initiative for Children’s Healthcare Quality (NICHQ) Healthy Weight Collaborative | In-person networking events and virtual learning sessions, webinars, coaching calls, peer networking calls, technical assistance calls |
Implementation of activities Developing action plans Engagement of community teams Project results Patient outcomes Online module usage patterns Documents submitted by teams |
Developed collaborative capacity among teams 34% of Phase 2 teams had an “above average” level of engagement Use of QI methods and performance measures helped teams make progress All teams adopted a healthy weight message, 59% implemented community-wide assessments and plans |
| Jamal-2017 [20] | United States | Quantitative descriptive | Otolaryngology residents | 11 | Integrating patient safety and quality improvement into resident education | Patient Safety and Quality Improvement (PSQI) curriculum | Interactive online modules, classroom group discussions, lectures by PSQI experts, self-directed workshops to develop projects |
Online module content and quality Number of projects developed Confidence in using QI |
IHI online modules are appropriate for patient safety and QI beginners and well accepted by participants Over half of residents found these modules to be ‘‘extremely’’ or ‘‘very’’ worthwhile |
| Keefer-2016 [21] | United States | Quantitative descriptive | House officers | 80 | Training house staff about basic QI techniques | Flipped classroom quality improvement curriculum | Online modules and in-person workshops | Participants’ QI knowledge, attitudes, behaviours |
Improved QI content knowledge Improved perceived readiness to participate in QI projects |
| Kennedy-2017 [22] | United States | Mixed methods | Faculty, staff, administrators, supervisors, data managers | 60 | Undertaking and sharing Continuous Quality improvement techniques |
Online quality improvement Information exchange | Web-based portal/website |
Experience with delivery mode QI delivery mode effectiveness, efficiency, satisfaction |
Results were overall positive and desirable Majority reviewers reported they would use the learning materials, complete quality improvement projects and reported the site would help address quality improvement challenges |
| Maxwell-2016 [23] | United States | Pretest/posttest control group design | Baccalaureate nursing students | 64 | Improving knowledge, skills, and attitudes regarding QI and safety | QSEN competencies | Online modules, flipped classroom |
Participants’ QI knowledge, attitudes, behaviours, and comfort Safety knowledge, comfort, and attitude |
Statistically significant effect between the groups for QI Experimental group had slightly higher knowledge scores than the control group for safety and QI Use of online modules in conjunction with the flipped classroom had a greater effect on increasing QI knowledge than the use of online modules only |
| Potts-2016 [24] | United States | Mixed methods | Family Medicine residents | 23 | Integrating residents to actively participate in quality improvement and patient safety activities | Integrated quality improvement residency curriculum | Web-based tutorials, quality improvement projects, small-group sessions |
Quality improvement skills Patient safety skills Chronic care management |
Participants of full curriculum reported higher use of knowledge Chronic care management and patient safety skill significantly improved for majority items Only one item (designing prospective chart reviews) was significantly improved for the QI skills category |
| Ramar-2015 [25] | United States | Quantitative | Fellowship trainees | 7 | Incorporating a QI curriculum into a training program | Flipped classroom (FC) model | Video lessons, half-day session, case examples, a hands-on workshop |
Learner reactions to training Participants’ QI knowledge, attitudes, behaviours |
Significant improvement in post-FC QI knowledge Overall positive reaction towards FC model |
| Scales-2016 [26] | United States | Randomised control trial | Resident physicians | 422 | Increasing learner participation in quality improvement education | QI curriculum | Spaced delivery of interactive healthcare quality questions via email |
Participation Participant engagement |
Residents in the intervention arm demonstrated greater participation than the control group Percentage of questions attempted at least once was greater in the intervention group versus control group Response time was faster in intervention group Team competition increases resident participation in an online course delivering QI content |
| Shaikh-2017 [27] | United States | Quantitative descriptive | Residents and faculty | 500 | Increasing resident and faculty knowledge in QI, patient safety, and care transitions | University of California Health’s Enhancing Quality in Practice online course | Three modules, questions sent on smartphones using an app, or on computers using e-mail |
Course completion QI knowledge Patient safety outcomes Preferences for mode of delivery |
Learners rated quiz-based system as an effective teaching modality and preferred it to classroom-based lectures Course completion rate between 66–86% Knowledge acquisition scores for, QI, patient safety and care transitions increased after course completion Course best utilised to supplement classroom and experiential curricula |
| Shelgikar-2017 [28] | United States | Mixed methods | Sleep medicine fellows | 7 | Developing skills to systematically analyse practice using quality improvement methods, and implement changes | QI curriculum using a flipped classroom | Online modules and group sessions |
QI knowledge Confidence in QI application Participation Project completion |
All participants completed the curriculum Knowledge of QI concepts and confidence in performing QI activities increased QI projects improved timeliness and quality of care for patients |
| Sorita-2015 [29] | Canada | Mixed methods | Secretaries, clinical assistants, registered nurses, nurse practitioners, physician assistants, physicians | Not stated | Running Plan-Do-Study-Act cycles to streamline examination process | QI curriculum | Didactics, workshop, online modules, and experiential learning | Improvement in care process |
Residents successfully applied QI methods to improve the efficiency of the DOT examination process Total visit time successfully reduced Accuracy of certificate issuance, as proxy for examination quality improved after intervention |
| Tappen-2018 [30] | United States | Randomised, controlled trial | Nursing Facility Residents | 264 | Improving the identification, evaluation, and management of acute changes | INTERACT quality Improvement Program | INTERACT tools, online training programme, webinars, an intensive initial training programme, monthly follow-up webinars | Patient safety outcomes |
No adverse effects on resident safety No significant differences in safety indicators between intervention and comparison group Intervention NFs with high levels of INTERACT tool use reported significantly lower rates of severe pain |
| Tartaglia-2015 [31] | United States | Observational study with control group | Fourth-year medical students | 34 | Improving QI knowledge | QI curriculum | Online modules, reflective writing, discussion with content expert, mentored QI project |
Comfort with QI principles Participants’ QI knowledge, attitudes, behaviours Projects completion |
Students in the intervention group reported more comfort with their skills in QI Curriculum strength included effective use of classroom time, faculty mentorship, reliance on pre-existing online modules Curriculum is expandable to larger groups and transferable to other institutions |
| Zubkoff-2019 [32] | United States | Mixed methods | Team leader, senior level support person, nurse, physician, nurse practitioner champion, pharmacist, and physical therapist | 60 | Enhancing knowledge, infrastructure, and capacity for QI | Virtual breakthrough series collaborative | Webinar-based educational format, open discussion sessions, “Meet and Greet” call with coaches, pre-work calls |
Learner reactions to training Report submission Patient safety outcomes |
No statistically significant decrease in total fall rates or major injury rates Significant improvement in fall related injury rate Majority were satisfied with the educational calls Minor injury rate decreased significantly Monthly report submission between 65 to 85% |