Date of Degree


Document Type


Degree Name

Doctor of Philosophy (PhD)




Osman Özturgut


Norman St. Clair


Jessica Kimmel


There is a great deal of healthcare literature on the importance of QI programs and the significant contributions they make toward patient safety and patient satisfaction; however, documentation of outcome measures and predictors of success remains challenging. This study examined the experiences of physician participants who attended a state supported South Texas medical school’s CSE course to gain an understanding of QI education, demonstrate the need for formal QI education, and determine if a change in clinical practice occurred as a result of attending a structured QI course. Kirkpatrick’s (1967) four-level evaluation model was used as a framework to guide the study in two key areas. The model was used to examine the experiences of the CSE physician participants to gain a better understanding of quality improvement, and it was used as a self-assessment instrument to determine baseline data of the physicians’ knowledge to help identify if a change in clinical practice occurred after graduating from the CSE course. Thirteen one-on-one interviews were conducted through self-evaluation questions. Participants shared their experiences and perceived outcomes about their own understanding of the quality principles learned in the CSE course and the framework in which they continued the CSE project’s implementation for their department or division. An adopted framework from Labov’s (1972) structural analysis and Kirkpatrick’s four-level evaluation model (1967) was used to help determine the effectiveness of the program and ways in which improvements could be made within the CSE physician graduates’ clinical practice. Through their shared experiences, the participants demonstrated the need for QI education and its ability to change clinical practice behavior. Results also revealed positive physician learner experiences. These positive experiences helped change how the physicians practiced within a clinical scope, helped shape the culture for the organization, and helped produce a progressive culture of self-development. Some of the physician learners expressed concerns in time management, funding, and support of leadership. In this study, the participants’ experiences were important to the success of QI initiatives within a healthcare system. If the system wants to practice effective QI efforts that provide a deep impact on clinical practice changes, the clinic leaders and administrators within the institution need to remain a fundamental component of the equation and most importantly of the education. The participants expressed a need to feel supported by their respective institution both monetarily and with designated protected time for QI initiatives. The participants often shared dual responsibilities as both administrators and clinicians, allowing them to provide a meaningful frontline perspective, which was instrumental in the change in clinician behavior. In addition, providing a QI course to all faculty, staff, and administrators established the tone and culture for the institution’s current and future goals.