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Background

Achieving Competency Today (ACT): Issues in Health Care
Cost, Quality, Systems, and Safety

The History

What Is ACT?
 Achieving Competence Today (ACT) is an innovative curriculum in health care systems and quality improvement. The first ACT curriculum was developed by Harvard’s Partnerships for Quality Education (PQE), a national initiative of The Robert Wood Johnson Foundation.

The original course content was designed as a four-week intensive curriculum with online as well as traditional face-to-face lectures/discussions.  At Christiana Care Health System, we modified the curriculum to provide a longitudinal interdisciplinary experience over 12 weeks for the participants.  This allows participants to increase retention; practice and improve interdisciplinary team skills; and enhance opportunities to synthesis and apply the course content.

The ACT model, which is preparing residents, graduate nursing students, nurses, allied health professionals, and other learners to address the performance challenges of the future, has three essential elements:

  1. An intensive, action-based learning curriculum that teaches learners about the health care system, health care costs, practice improvement, and quality improvement.
  2. Interdisciplinary learning through collaboration on a quality improvement project.
  3. Connecting the learners with the institution’s senior quality leadership. 

There is little argument that today’s clinicians need to be competent in systems-based practice and practice-based learning and improvement and in working collaboratively with colleagues from other disciplines. The challenge is how to do this in a way that engages learners. The ACT curriculum is designed to link learners, who provide the majority of care in academic health centers, with those in their organization whose mandate it is to improve quality. The ACT model is designed to test whether linking learners with quality improvement leadership, giving them the tools they need to design solutions to the real world problems, and structuring their work so that they see the power and the necessity of collaboration can be a significant force for change in the nation’s academic health centers.

In 2007, Christiana Care Health System was one of six “top performing ACT sites” identified by the Robert Wood Johnson Foundation.  Christiana Care Health System has participated in the Partnerships for Quality Education national initiative since 2005. Other top performing sites include University of Pennsylvania, University of Virginia, Johns Hopkins University, University of Missouri, and Harvard affiliated Beth Israel Deaconess Medical Center.

The ACT programs are highly effective in teaching the principles and practice of performance improvement. Two important aspects of the program are unique: 1) learners work together as a team to identify a specific performance improvement project, devise a plan to address the issue, and implement the plan; and 2) the issues addressed are chosen by the learners. They are not theoretical, but rather real-time improvement opportunities at Christiana Care Health System. Thus, the learners are making a contribution at the same time that they are learning.

Original Four Module Concept
In 2005, Christiana Care used the original ACT curriculum, a concentrated four-week program with intensive curriculum offering online as well as traditional face-to-face lectures and discussions. This was the original Harvard PQE ACT curriculum.

Module One – The Health Care System and how it affects the care you deliver
Module Two – Who pays for care and why it matters
Module Three – Improving the care of individuals, populations, and practices
Module Four – Improving your practice and educating others

Revised Twelve (12) Week Course
In 2006, Christiana Care Health System expanded the curriculum to 12 weeks to allow residents to participate over several blocks and to be more compatible with the University of Delaware graduate nursing curriculum. This allowed participants to: increase retention; practice and improve interdisciplinary team skills; and enhance opportunities to synthesis and apply the course content.

Course Dates at Christiana Care Health System

  • November 15, 2004 – May 1, 2005
  • February 13, 2006 – May 1, 2006
  • January 10, 2007 – March 28, 2007
  • September  5, 2007 – November 28, 2007
  • January 9, 2008 – April 2, 2008
  • September 10, 2008 – December 3, 2008 (in planning stages)

Who Have Been the Faculty?
Since 2004, 30 faculty members have been involved in lectures, discussion, and facilitation of the learners.  Our course faculty have included senior leaders, such as the President and CEO, Associate Chief Nursing Officer, Chief Medical Officer, as well as content experts from numerous departments including Nursing, Academic Affairs, Finance, Quality and Patient Safety, Institutional Review Board, and Care Management.

Who Have Been the Learners?
Since its inception, the learners have ranged in number and in representation of clinical disciplines. They include: 

2004 / 2005 - 6 residents, 2 nurses
2006  - 4 residents, 4 nurses
2007  -  14 residents, 18 nurses, 4 allied health
2008  -  9 residents, 8 nurses, 1 allied health

What Have Been the Projects?

 Year

 Project Title

 2005 

 Reducing fragmentation of care of the ambulatory patient at a family medicine center (Family Medicine).
  Reducing medication related morbidity in the clinic (Internal Medicine).
  Improving PICC Lines Peripherally Inserted Central Catheters: A look at Performance Improvement Initiatives.
  Quality Improvement Plan.
  A Triage Protocol: Early Intervention for the Pneumonia Patient.
 2006 First, Do No Harm: Reducing Inpatient Risk to Fall.
  Reducing Nosocomial Anemia.
 2007 MRSA Clearance: One Step Closer.
  Back to the Bedside: Changing the Way We Round.
  Reducing 1B Isolation Codes at Wilmington Hospital.
  I Wash My Hands…Do You? Improving Hand Washing Compliance.
  Have You Web Paged Today?
  Improving Allergy Documentation in Powerchart.
  Vein Illumination – Shedding the Light on Successful IV Access.
 2008  Reducing Unnecessary Prescribing of “Acid Suppressive Therapy.”
  To Code or Not To Code: Improving timely identification of limitations of treatment forms on patient charts.
  What search engine? Improving an inaccurate and under-utilized resource.

 

Magnet recognition for excellence in nursing CarePages Delaware Health Sciences Alliance
Christiana Care Health System PO Box 1668, Wilmington, DE 19899 Contact Us www.christianacare.org
Christiana Care is a private not-for-profit regional health care system and relies in part on the generosity of individuals, foundations and corporations to fulfill its mission. To learn more about how you can support our mission, please visit christianacare.org/donors.