When you think of a PA’s job description, you might not think of quality improvement (QI). But fostering QI skills in PA students is vital to meet the legislative, academic, and professional demands of future health care providers. The Affordable Care Act mandates participation in ongoing QI, and for PAs, NCCPA requires that a portion of Category 1 continuing medical education (CME) credits involve self-assessment or performance improvement. In addition, ARC-PA Accreditation Standards call for instruction on patient safety and QI (B2.13).
Still, a cross-sectional study in 2015 from the University of California–Davis suggests limited exposure to QI in PA program curricula. In a survey of faculty at 12 PA programs, only 15 percent of respondents indicated all of their students participated in QI projects, while 38 percent indicated their students did not. These findings illustrate a need for PA programs to offer opportunities for QI projects, which will greatly expand the variety of roles PAs can perform in the health care industry.
So how exactly can QI benefit future PAs and health care as a whole? A background in QI can add value to both the individual and the profession by encouraging a PA to…
…engage in self-improvement
Sure, the NCCPA requirements for CME specify “self-assessment or performance improvement,” but what exactly does that mean? How can this be a valuable use of a PA’s time? It seems like everybody has an opinion about how medicine could be better, but how many people have the tools to create effective and sustainable change? Early exposure to QI in PA school can ensure that future PAs are prepared to meet these demands. By learning how to conduct a root cause analysis, establish aims, and identify measures of effectiveness for a QI intervention, students can apply these concepts to their own self-assessment and performance improvement with established and validated tools. Measure twice, cut once.
…not only practice in the clinic, but improve the clinic
There is an ongoing discussion about the opportunities to add value to a PA’s career, including technical and procedural skills or speaking a foreign language. The skills and language associated with QI are an additional way for a PA to do this. A PA with experience in planning and executing a QI project can be a valuable asset to a clinical practice site. QI projects involve a variety of topics, and while many are focused on the Triple Aim (improving the patient care experience, improving population health, and reducing the per capita cost of health care), QI is often initiated to understand how an intervention can generate revenue or reduce expenditures for a practice.
For example, a PA who applies QI knowledge to increase patient volume through better patient flow, to decrease unnecessary costs by adhering to best practices, or to reduce “never events” by implementing the most current guidelines, adds more than their clinical expertise to a practice — they add recognizable value as well.
…enhance the profession outside of the exam room
Two major programs from the Centers for Medicare & Medicaid Services — Hospital Value-Based Purchases and Hospital Readmissions Reduction — challenge all providers to constantly apply QI skills. Commentary by Sanjay K. Saha, MHS, in the September 2015 issue of JAAPA discussed how the roles of PAs are expanding as the demands for greater accountability and transparency increase. PA students who complete QI courses will be better prepared to analyze data on patient outcomes and process expenses, as well as create effective interventions in teams. These skills open new doors for PAs as their QI knowledge — combined with clinical expertise — offers value in administrative roles. Even without an administrative career, PAs have a place at the table in this discussion, and an understanding of QI can secure their seat at the table and improve their contributions.
…strengthen education for future PAs
Improving the medical knowledge and clinical expertise of PA students to prepare them for future careers is a never-ending process. Learning about QI concepts is a way to prepare PAs for careers in education as preceptors, instructors, clinical coordinators, or program directors.
- A preceptor may want to know how they can maximize the time that students spend in their clinic but wonder how they can accomplish this and still secure a spot for an additional PA student.
- An instructor might want to know how to improve knowledge retention from a lecture but wonder how to measure the effectiveness of a change in their presentation.
- A clinical coordinator could be concerned about how to make the process of scheduling students and retaining high quality preceptors less time consuming.
- A program director should know how to document the value of their PA program’s progress in the ongoing accreditation cycle.
You can see that, for all of these PA education roles, QI skills are a valuable tool for creating solutions and measuring the success of an intervention. In addition, a PA educator with QI experience can add value to their PA program by introducing QI to their students.
… advocate for their profession
Harry Truman is often quoted as saying “Decisions are made by those who show up.” But one also needs to show up with the right tools. Learning QI is learning the language of innovation.
As PAs look to advance their roles in health care, education, and policy, QI skills are valuable to expanding networks. Greater exposure to QI in PA education will enhance the ability of PAs to advocate by participating in the QI discussion at academic, administrative, and legislative levels. A PA can make valuable contributions to health care innovation teams — joining other professions like physicians or nurses in the decision-making process.