How are competencies being used to monitor the quality of respiratory care

• To deliver a national calibre, cutting-edge curriculum

• Enhance and develop relevant faculty breadth of experience

• Recruit and retain highly qualified and diverse student cohorts (1)

From these objectives, we developed specific actions that will be measured over a period of time, with most measurements occurring on an annual basis. Expanding on the first objective, our actions are the following:

• Develop a new Bachelor of Medical Rehabilitation in Respiratory Therapy (BMR-RT) curriculum

• Increase stakeholder and clinical community involvement

• Enhance simulation delivery within the academic portion of the program

Each action has several performance measures with subsequent outcomes. The outcomes are the descriptors of success. The remaining three strategic initiatives were mapped in a similar manner to complete the quality roadmap for the RT education program. Strategic plans look impressive on paper and can be intimidating, but if the plan is analyzed one strategic initiative at a time, it becomes manageable and doable in the time frame allotted.

I believe that a strategic plan tells you where you are going, it becomes your destination, and the quality roadmap tells you how you are going to get there. Goals of the organization or program are identified and, when the goals are achieved, you have reached your destination. The actions that you take to reach those goals become the directions that you follow along the map.

Actions produce outcomes and, with many health care profession education programs providing Bachelor’s or Master’s degrees as entry-to-practice, our educational institutions need to ask, ‘What is the best possible outcome that we can provide for our students?’ The Canadian Society of Respiratory Therapists has created a position statement advocating for a degree as entry-to-practice for RTs in Canada (2). This is not about ‘keeping up with the Joneses’, but about keeping up with the changing face of health care. “The graduate RT must be prepared to enter the workforce as the expert on respiratory care and be prepared to consult on the provision of care” (3). This requires our students not only to be competent in using respiratory therapy equipment, but also to be able to apply evidence-based knowledge to manage and treat patients. We are teaching our students what it means to promote a culture of client-centred care, in which clients, patients, family members and all members of the health care team have a voice in what care is delivered and how it is delivered. In addition to ensuring that all components of the national competency profile are incorporated and measured in our curriculum, we must teach what it means to be a health care professional in the 21st century. We want our students to learn to deliver respiratory therapy services using different models of care in diverse settings. We want them to develop leadership skills that will aid them in decision making and navigating team dynamics and conflict.

In spring 2011, the University of Manitoba RT program began the process of curriculum renewal. We deconstructed each course and matched the objectives to the national competency profile. This enabled us to identify redundancies between courses as well as areas that needed more clearly defined objectives. Two such areas are interprofessional education and patient safety. In 2008, the University of Manitoba Interprofessional Education Initiative was formed by administrators, faculty and students from 13 academic units with the belief that interprofessional education for collaborative patient-centred practice is fundamental in building a stronger health care system (4). These learning opportunities enable students to learn ‘from, with and about each other’ (5). The interprofessional curricula framework has been mapped into the new RT curriculum so that our students will learn and practice how to collaborate with other health professions to promote optimal health outcomes for individuals and communities, increase satisfaction with care for both individuals and health care providers, and improve efficiencies within the health care system (5).

Another area of competencies that we addressed is related to patient safety. The Canadian Patient Safety Institute (CPSI) has developed a framework of safety competencies required by health professionals to promote a culture of safety. The intent of these competencies is to “raise the bar for health care education in Canada, and possibly around the world” (6). The CPSI competencies have been mapped into the respiratory therapy curriculum, and our students will be provided with interprofessional learning opportunities to practice their role and collaborate with other health profession students in providing safe, quality care.

We are preparing our students to graduate with the skills to further their careers in research related to respiratory therapy, to continue to grow as collaborative health care practitioners and become leaders in the field. Similar to all respiratory therapy practitioners, managers and educators in any sector, we are dedicated to preparing the future of our profession.

It is our intent that the strategic plan and quality roadmap of the respiratory therapy program at the University of Manitoba will keep us on track to deliver a quality education program. We will be able to measure our progress and make changes as needed so that we can, in fact, measure the quality of our respiratory therapy education program. Now that I am in my fourth year of teaching, and 20th year in the profession, I continue to ask myself the same questions I have asked since graduating: Am I doing my job right? Am I doing the right thing?

1. What are respiratory care protocols?
They are guidelines for delivering appropriate respiratory care treatments and services.

2. What are the skills needed to implement protocols?
(1) Assess patients for indications of therapy and the most appropriate method, (2) Be cognizant of age-related issues and how they affect the patient, (3) Adapt hospital policies and procedures to other care sites, (4) Conduct and participate in research activities, and (5) Communicate effectively with all members of the healthcare team and contribute to the body of literature concerning the field of respiratory care

3. What are the nine steps of a quality assurance plan?
(1) Identify the problem, (2) Determine the cause of the problem, (3) Rank the problem, (4) Develop a strategy for solving the problem, (5) Develop appropriate measurement techniques, (6) Implement strategies, (7) Analyze and compile results, (8) Report to appropriate personnel, and (9) Evaluate the outcome

4. What are the professional characteristics of a respiratory therapist?
They must complete an accredited respiratory therapy program. They must obtain professional credentials. They must participate in continuing education activities. They must adhere to the code of ethics put forth by the state or institution. They must join professional organizations.

5. What does CQI stand for?
Continuous Quality Improvement

6. What is evidence-based medicine?
It is an approach that relies on the following practices: A rigorous and systematic review of evidence, critical analysis of available evidence, and a disciplined approach to incorporating the literature with personal experience and practice.

7. What is quality?
In healthcare, quality reflects a high degree of excellence, fineness, or grade.

8. Who is usually professionally responsible for the clinical function of the respiratory department?
A medical director is typically responsible for the respiratory department. They are often either a pulmonologist or anesthesiologist.

9. What are the three elements of quality care?
Personnel, equipment, and the method/manner in which care is provided

10. What are the four essential components of disease management?
(1) An integrated health care system that can provide coordinated care across the full range of patients’ needs, (2) A comprehensive knowledge base regarding the prevention, diagnosis, and treatment of disease that guides the plan of care, (3) Sophisticated clinical and administrative information systems that can help assess patterns of clinical practice; and (4) A commitment to continuous quality improvement

11. What is the CoARC responsible for?
It is responsible for the quality of schools’ programs.

12. What are cohort studies?
They compare the clinical outcomes in two compared groups. They generally have greater scientific rigor than case studies or case series and consist of two broad types of study designs: (1) Observational cohort studies and (2) Randomized controlled trials.

13. What are competencies?
Having a suitable or sufficient skill, knowledge, and experience for the purposes of a specific task

14. The crucial elements for quality respiratory care include what?
(1) Energetic and competent medical direction, (2) Methods for providing indicated and appropriate respiratory care, (3) Educated, competent respiratory care personnel, (4) Adequate, well-maintained equipment, and (5) Intelligent system for monitoring performance improvement

15. What is disease management?
An organized strategy of delivering care to a large group of individuals with chronic disease to improve outcomes and reduce cost

16. What are protocols?
Guidelines for delivering appropriate respiratory care services that can improve the allocation of respiratory care services

17. What does evidence-based medicine use to find the best care?
It uses meta-analyses to find the best care.

18. What is the “licensing” process for respiratory therapists?
After completion of an approved respiratory care educational program, a graduate may become credentialed by taking the TMC examination and passing with the high-cut score to obtain the CRT credential. A CRT may be eligible to sit for the CSE examination to become a credentialed RRT.

19. What is an important part of evidence-based respiratory care?
Communication

20. What is the Joint Commission (TJC)?
A private, not-for-profit organization that evaluates and accredits hospitals and other healthcare organizations on the basis of predefined performance standards; formerly known as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)