To help rural Texas hospitals improve the quality of their healthcare, the Texas Office of Rural Health (TX SORH) is fostering “quality champions” in every region of the state.

“In Texas we’re not immune to the high rate of turnover in our hospitals—which includes our quality champions,” said Trenton Engledow, TX SORH Director. “The idea of our Quality Improvement Training Program (QITP) is to have an intense training that helps a handful of these champions become trained and certified for the CPHQ (Certified Professional in Healthcare Quality) exam.”

The CPHQ exam is often regarded as the standard in certifications for individuals in healthcare quality management. While it is unknown how many individuals in rural Texas have CPHQ certification, Engledow estimates that it is not widely obtained. “Through this program we hope to encourage individuals at our rural hospitals to strive for it, to better their reporting, and to improve the healthcare they provide,” he said.

As part of the program, TX SORH also is creating a fellowship program for QITP participants. “After they sit for the CPHQ exam they will be expected to reach out to other hospitals in their regions to help them work on quality issues,” Engledow said. (TX SORH has divided the state into six regions.)

“The goal is to create a collaborative, fellowship-type environment among all our champions,” he said.  Towards this effort, TX SORH is creating an online network—including a small Facebook group of graduates—“so they can stay connected after the program is done and find support among themselves,” he said.

In its first session, which ran from June 2019 to May 2020, the QITP program had eight participants, and classes were held monthly. Fifteen people have signed up for the second session. “We were hoping to expand it, but for our contractor providing the training, 15 has been a number that they find manageable where they can have one-on-one instruction, and have a more intimate learning experience,” Engledow said.

In the second session, which began in July and will finish in December, each training session will be two-hours long, held biweekly over six months, for a total of 20 hours of training, said Maria Bustamante, Rural Health Specialist at the TX SORH, who manages the QITP program. “The first year was a combination of in-person and virtual training, but after the pandemic this year, it moved entirely to virtual and the next session will be 100 percent virtual,” Bustamante said.

The approach of the program is two-fold. During their training period, participants are expected to implement quality improvement (QI) projects at their hospitals, with support from their instructors and their hospitals’ leadership. Some of the QI projects implemented at their hospitals in the first year include refining the discharge process to decrease wait times, ensuring trauma transfers are done within the recommended two-hour time frame, improving patient satisfaction, and expanding the internal audit program.

After the training period is over, participants are expected to continue to work on ongoing QI projects at their hospitals and in their region.

The cost of the CPHQ training comes from a portion of each facility’s SHIP grant, Engledow said. “Each facility that participates opts to use a portion of their SHIP funding for the program cost that we hold back out of their SHIP award.” SHIP funding is not eligible to cover the exam fee, he said. “So we’re asking each facility to cover the exam fee for individual participation in the program.”

Because its first session has just ended and its participants had not yet taken the CPHQ exam, Engledow said, “the program is still too new to measure any success.” But, he cannot envision a time when this program will not be needed in Texas.

“With all the turnover we experience, I don’t see this program ever going away,” Engledow said. “We are such a large state, and we work with 163 hospitals. Even without staff turnover, it would take 10 to 15 years to get to all the hospitals—and that’s with training just one person in each hospital.”

“We firmly believe that QITP is key to the overall QI performance of rural hospitals in Texas,” Bustamante added. “TX SORH is committed to helping rural hospitals stay open for their communities and deliver the best care possible through an increased knowledge of QI and collaboration led by their own Quality Champions.”

The goal is to have certified QI professionals in every rural area,” Bustamante concluded. “There’s so much to cover!”