The Cactus Cowboys had 45 minutes to deliver an imaginary pizza. But to complete the order, they would have to crack codes, solve a puzzle, and identify the root cause of problems they encountered along the way.

Everything was going well during the Great Pizza Delivery Race at UT Southwestern – that is until the team could not open a combination lock attached to an envelope that contained the next clue in the challenge.

“There is definitely a sense of urgency,” said Khawar Nawaz, M.D., a UTSW clinical fellow in the Division of Neonatal-Perinatal Medicine and an M.P.H. Scholar at the Peter O’Donnell Jr. School of Public Health as he focused on opening the lock. “It shows how vital teamwork is in a high-pressure situation.”

Teamwork is one of the major lessons of the UT Southwestern Quality Improvement Boot Camp, which marked its 10-year anniversary in June. The camp brings together interdisciplinary teams to learn skills they can use to solve hypothetical health care problems.

Team Blue Snakes celebrates after successfully standardizing its process for the catapult activity. By using a control chart to track performance, the team demonstrated consistent accuracy and reliability in results.

The weeklong camp mixed lectures on quality improvement (QI) tools with fun exercises such as the Great Pizza Delivery Race, which was modeled after an escape room. Participants had to complete tasks such as creating a process map for a pizza delivery order before they advanced to the next challenge.

By the end of the week, participants had learned new ways of solving problems, said William Gary Reed, M.D., Associate Dean of Quality, Safety, and Outcomes Education at UTSW.

Growth over a decade

Since the Quality Improvement Boot Camp was introduced in 2015, it has been one of the most popular activities in the Office of Quality, Safety, and Outcomes Education, Dr. Reed said.

“The course provides participants the opportunity of learning a team approach to addressing problems of quality and patient safety in health care,” he said. “Since the program started 10 years ago, 354 participants have completed the course: 164 UTSW medical students, 88 UTSW nurses, 88 industrial engineering students from UT Arlington, and 14 faculty or fellows from UTSW.”

This year, students from the O’Donnell School of Public Health and the School of Health Professions joined the boot camp.

William Gary Reed, M.D.

For the activities, six teams composed of 17 UTSW medical students collaborated with three engineering students from UT Arlington, six nurses from William P. Clements Jr. University Hospital, one fellow from the O’Donnell School of Public Health, and two staff members and two students from the School of Health Professions.

Challenges in health care settings – such as prolonged clinic wait times, delays in laboratory test results, and inpatient falls – can effectively be addressed through the application of QI methodologies and tools, said Mozhdeh Sadighi, Ph.D., an Industrial and Systems Engineer at UT Southwestern. The boot camp teaches some of these QI tools and methodologies, such as control chart, Pareto chart, process map, root cause analysis, and PDSA (plan, do, study, act) cycle, but also includes fun and competitive teamwork activities, she said.

“We wanted to do activities that got them up on their feet and not just sitting all day listening to lectures,” Dr. Sadighi said. “So we had them perform tasks such as solving a puzzle, popping balloons, or searching under chairs for clues that would not only help them solve the challenges integrated into the pizza delivery race using the QI tools they learned throughout the week, but also teach them how to collaborate effectively as a team under pressure.”

Members of the Etna Team, who rang a cowbell when they won the Great Pizza Delivery Race, agreed that the activity helped them learn the importance of collaborating, delegating, and ensuring everyone is on the same page.

“The boot camp gives you a lot of tools you can use during your career,” said Zachary Miller, a graduate student at UT Arlington.

At the end of the week, participants gave presentations on theoretical problems that they analyzed, such as late arrivals at clinics.

New tools to improve patient care

Upon completing the boot camp, the medical and engineering students moved on to a seven-week summer program that paired them with UTSW clinical faculty members working on QI projects. UT Arlington students earned a certificate and three hours of credit for a systems engineering course. For the USTW medical students, the camp is part of the Quality Improvement and Patient Safety track, which provides them with 24 weeks of extensive QI training. It is mandatory for all medical students who wish to graduate with the designation of Doctor of Medicine with Distinction in Quality Improvement and Patient Safety. The UTSW nurses who participated in the boot camp earned a certificate.

Interdisciplinary team members review a SIPOC (suppliers, inputs, process, outputs, customers) diagram during the Great Pizza Delivery Race, applying quality improvement tools to strategically guide their next move.

Team members left with the skills to apply quality improvement tools, but eventually they will decide which methodology works best for them in their careers, Dr. Reed said.

“We give them a ‘cookbook’ with probably hundreds of different tools,” he said. “They’ll get really good at eight or nine of the tools and end up using those 99% of the time.”

By putting the problem-solving skills learned at the boot camp into practice, participants will help improve health care.

“The many quality improvement projects that have been completed by the participants have contributed to the success of UTSW in becoming one of the leaders in patient safety in the United States,” Dr. Reed said.