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sicians there received a grant to study whether a new approach to ventilator care could help treat acute respiratory distress syndrome. The success of that study led several Intermountain depart- ments to begin quality improvement ef- forts of their own, and Intermountain eventually developed the Advanced Training Program to spread the concept to other health care systems. Frank Villamaria, MD, former medi-

cal director for quality at Scott & White Healthcare in Temple, took the course in 1997. He describes it as a “very ex- tensive” program that combines didactic information about quality and quality improvement with a hands-on experi- ence in actually conducting a quality im- provement project.

That, he says, gets participants in-

volved in actually putting what they’re learning into practice. Dr. Walters says some of the indus- trial concepts included in the course in- volve the so-called “lean” methodology — a process Toyota and other manufac- turers use to focus on eliminating waste — and a process called Plan, Do, Check, and Act (PDCA). He describes PDCA as a “classic” methodology that stresses identi- fying a problem, planning how to make improvements, deciding how to measure improvement, and implementing the plan, and then measuring its impact.

Managing change

The Intermountain course involves four five-day sessions spread over four months and includes instruction in developing guidelines and protocols;

health services research methods; health policy and economics; cost-based ac- counting medical informatics; severity of illness measurement; and total quality management and continuous quality im- provement. The course also stresses the role of interprofessional teams in quality improvement. Participants must carry out a quality

improvement project and present its re- sults to graduate. Tuition for the course is $9,000 per participant. Dr. Villamaria says the concept of total quality management is very impor- tant. “Quality improvement is not just crunching numbers but understanding how to manage change,” he said. “If you’re going to improve anything, you’ve got to change it. That’s sometimes the biggest challenge: to get people comfort- able with change.”

Learn more about quality improvement

Interested in learning more about quality improvement? Baylor Health Care System (BHCS) offers its Advancing Best

Care course to outside organizations, and The University of Texas System institutions offer slots in their Clinical Safety and Effectiveness (CS&E) course on a space-available basis. Cost of the full BHCS course is $2,500 per participant. UT’s

M.D. Anderson Cancer Center charges only for course materials for outside participants in its CS&E course. For information about the BHCS course, email Neil Fleming,

PhD, at BHCS at, or call (214) 265- 3601. Physicians interested in the M.D. Anderson course should email Doris Quinn, PhD, at, or call (713) 745-2579. And physicians interested in attending the UT Health Science

Center at San Antonio CS&E course should contact Letti Bres- nahan at the UTHSCSA Center for Patient Safety and Health Policy at (210) 567-4445.

46 TEXAS MEDICINE September 2012

M.D. Anderson and BHCS developed the courses with assistance from Dr. James at Intermountain, but both chose to implement a somewhat condensed version. The M.D. Anderson courses — as well as those at the UT Health Science Center at San Antonio (UTHSCSA), UT Health Science Center at Houston, and UT Southwestern Medical Center — in- clude eight days of instruction with time for a quality improvement project. Dr. Walters says each campus’ version of the course varies. Some stress the lean principles, while others focus more on the PDCA approach. Jan Patterson, MD, associate dean for quality and lifelong learning at UTHSC- SA, says the San Antonio course differs from the others because it involves cli- nicians, administrators, and others from affiliated hospitals that are not actually part of the UT System. More than 600 physicians and oth-

ers have graduated from the various UT courses, and they have completed more than 260 quality improvement projects at their institutions. The BHCS course has a similar design, but includes only five days of classroom instruction. BHCS also offers a one-day version of its program. Neil Fleming, PhD, vice president and chief operating officer of BHCS’s STEEEP Global Institute, said the BHCS course is also organized around the “six domains

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