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Building the Bridge to Quality

An Urgent Call to Integrate Quality Improvement and Patient Safety Education with Clinical Care

Wong, Brian M. MD; Baum, Karyn D. MD, MSEd, MHA; Headrick, Linda A. MD, MS; Holmboe, Eric S. MD; Moss, Fiona CBE, MD; Ogrinc, Greg MD, MS; Shojania, Kaveh G. MD; Vaux, Emma MD, PhD; Warm, Eric J. MD; Frank, Jason R. MD, MA(Ed)

doi: 10.1097/ACM.0000000000002937
Article: PDF Only

Current models of quality improvement and patient safety (QIPS) education are not fully integrated with clinical care delivery, representing a major impediment toward achieving widespread QIPS competency among health professions learners and practitioners. The Royal College of Physicians and Surgeons of Canada organized a 2-day consensus conference in Niagara Falls, Ontario, Canada, called Building the Bridge to Quality, in September 2016. Its goal was to convene an international group of educational and health system leaders, educators, front-line clinicians, learners, and patients to engage in a consensus-building process and generate a list of actionable strategies that individuals and organizations can use to better integrate QIPS education with clinical care.

Four strategic directions emerged: Prioritize the integration of QIPS education and clinical care; build structures and implement processes to integrate QIPS education and clinical care; build capacity for QIPS education at multiple levels; and align educational and patient outcomes to improve quality and patient safety. Individuals and organizations can refer to the specific tactics associated with the 4 strategic directions to create a roadmap of targeted actions most relevant to their organizational starting point.

To achieve widespread change, collaborative efforts and alignment of intrinsic and extrinsic motivators are needed on an international scale to shift the culture of educational and clinical environments and build bridges that connect training programs and clinical environments, align educational and health system priorities, and improve both learning and care, with the ultimate goal of achieving improved outcomes and experiences for patients, their families, and communities.

B.M. Wong is associate professor of medicine, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, and associate director, Centre for Quality Improvement and Patient Safety (C-QuIPS), Faculty of Medicine, University of Toronto, Toronto, Canada.

K.D. Baum is professor of medicine, and adjunct professor, School of Public Health, and associate chief medical officer, University of Minnesota, Minneapolis, Minnesota.

L.A. Headrick is professor emerita of medicine, University of Missouri School of Medicine, Columbia, Missouri.

E.S. Holmboe is senior vice president for milestones development and evaluation, Accreditation Council for Graduate Medical Education, Chicago, Illinois.

F. Moss is dean, Royal Society of Medicine, and academic lead for collaboration, learning and partnerships, North West London Collaboration for Leadership in Applied Health Research and Care, London, United Kingdom.

G. Ogrinc is professor of medicine, The Dartmouth Institute, and senior associate dean for medical education, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.

K.G. Shojania is professor and vice chair of quality and innovation, Department of Medicine, University of Toronto and Sunnybrook Health Sciences Centre, and director, Centre for Quality Improvement and Patient Safety (C-QuIPS), Faculty of Medicine, University of Toronto, Toronto, Canada

E. Vaux is a consultant nephrologist, Royal Berkshire National Health Service Foundation Trust, Reading, and vice president of education and training, Royal College of Physicians, London, United Kingdom.

E.J. Warm is professor of medicine and program director, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio; ORCID:

J.R. Frank is associate professor, Department of Emergency Medicine, University of Ottawa, and director, Specialty Education, Strategy and Standards, Office of Specialty Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada.

Supplemental digital content for this article is available at

Acknowledgments: The authors would like to thank the 37 members of the Building the Bridge to Quality Program Advisory Board. We would also like to acknowledge Ms. Ginette Bourgeois of the Royal College of Physicians and Surgeons of Canada for the administrative support provided to the Building the Bridge to Quality initiative.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Correspondence should be addressed to Brian M. Wong, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room H466, Toronto, Ontario, Canada M4N 3M5; telephone: (416) 480-6100 ext. 83709; email:

© 2019 by the Association of American Medical Colleges