Dr Simon Kitto PhD

Mapping Practice Boundaries & Intersections Between the Domains Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement Dr Simon Kitto PhD

Disclosure • This research is funded by the AFMC national CPD fund

Overview • Background and study objectives • Research methods • Findings • Discussion of Significance to CE

Background • The domains CE, PS, QI and KT have overlapping agendas of improving healthcare • However, there is little evidence that explores the current state of relationships across these four areas

Objective • To explore key informants’ understandings and perceptions of CE, PS, QI and KT and their relationships • This research aims to provide a platform for interdisciplinary discussions and inform future collaborations

Sampling • Key informants is defined as actively participating or doing research in the domain(s) in Canada

Data Collection 20 Interviews 5 Continuing Education 5 Patient Safety5 Quality Improvement 5 Knowledge Translation

Data Analysis • Directed content coding • Major themes about perceptions of CE, QI and KT were synthesized • Analysis was informed by three theoretical frames: boundary work (Gieryn, 1983), epistemic cultures (Knorr-Cetina, 1999) and governmentality (Dean, 2010)

Theoretical Triangulation • Governmentality - viewing domain areas as technologies of governing • Epistemic cultures - examining the culture of sciences of interventions and the professions who do and do not work together • Boundary work - how different knowledge bases perform professional/disciplinary closure, that form the identity of each domain

THE PERCEIVED INTERSECTIONS BETWEEN THE DOMAINS OF CONTINUING EDUCATION, QUALITY IMPROVEMENT AND KNOWLEDGE TRANSLATION Preliminary Findings

Silos • Domains are different, but interrelated • Historical and economic factors contribute to domains working in silos

“There is often competition for resources and, if they’re pigeon-holed into quality or safety or knowledge translation or CME, everyone’s fighting for their resources. It’s not natural for them to play together in the sandbox and so I think there’s a bit of resistance because of the silos.” (QI 4)

Positioning CE, QI and KT • CE takes place outside of the workplace • QI is located in the workplace • KT occurs along the continuum of stakeholders involved in healthcare

Other domain perceptions about CE • Individual focus • Focused on knowledge and skills • Separate from work place • Driven by financial factors • Passive participation • No mandate to change clinical behavior

“Everyone thinks that education’s good and the solution always to guidelines or poor care is, ‘we need more education’. But whether that education is designed properly, whether the right people get the education, whether there’s follow-up, it’s all sort of a bit loose. Then, the challenge is even if you go and learn something in a setting… because education currently right now is given completely separate from your workplace… then when you come back to your workplace and you try to implement stuff, there’s usually all kinds of barriers of why you can’t do this.” (QI 1)

Relationship between CE and QI • CE as a component of QI • The rigour of CE in QI needs more attention • CE about QI as a topic area • Changing focus of CE from individual to system level

“I think continuing education needs to be much more acknowledged and it needs to be more robust, but it needs to be considered as an intervention in and by itself, which needs fleshing out, expansion and all of that in the quality improvement space...” (CE 2)

Relationship between CE and KT • CE is one intervention of KT toolbox • KT “science” can underpin CE practices and research • KT research (gap analysis) can provide valuable information to inform CE interventions

“I think again this movement towards the interrelation of continuing education, knowledge transfer and knowledge application is also feeding back into the way in which we provide education. We structure it far more with a view to that knowledge being transferred and applied in a real situation. I think for sure the increased pressure on continuing quality improvement and patient safety is bringing a new dimension too into the way we teach, so that it becomes a more important factor in giving us the unperceived need for sure, that hadn’t come across people’s thought-processes until fairly recently.” (CE 3)

Significance of Study Discussion

Significance to CE • There are multiple ways for CE to support QI • Need to think more critically about how to integrate CE and QI

References Britten N. Qualitative Research: qualitative interviews in medical research. British Medical Journal. 1995; 311:3. Dean M. Power at the heart of the present: Exception, risk and sovereignty. European Journal of Cultural Studies. 2010; 13: 459-475. Gieryn TF. Boundary-Work and the Demarcation of Science from Non-Science: Strains and interests in Professional Ideologies of Scientists. American Sociological Review.1983; 48(6): 781-795. Hsiesh, HF, Shannon SE. Three approaches to Qualitative Context Analysis. Qualitative Health Research. 2005; 15(9): 1277-1288.

References Kitto S, Bell M, Peller J, Silver I, Etchells E and Reeves S. Improving Patient Outcomes: Mapping Practice boundaries and intersections between the domains of Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement, Advances in Health Sciences Education. 2011; online first December 2011. Knorr-Cetina K. Culture in global knowledge societies: knowledge cultures and epistemic cultures. Interdisciplinary Science Reviews. 2007; 32(4): 361-375. Liamputtong P, Ezzy D. Qualitative Research Methods. Oxford: Oxford University Press; 2005. Shojania KG, Silver I, Levinson W. Continuing Medical Education and Quality Improvement: A match made in heaven? Annals of Internal Medicine. 2012; 156: 305-308.

Mapping practice boundaries and intersections between the domains of Continuing Education, Knowledge Translation, Patient Safety and Quality Improvement Kitto S, Bell M, Peller J, Sargeant J, Etchells E, Reeves S, Goldman J, Silver I.

Dr Simon Kitto PhD