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VHA National Center for Patient Safety

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Advanced Fellowship in Patient Safety

Program Vision:

"To be the leading health professions education program in quality improvement and patient safety."


Established 2005, the Advanced Fellowship in Patient Safety (AFPS) program is a collaboration of the NCPS and the Office of Academic Affiliations (OAA) to establish an interprofessional patient safety training program. The purpose of the program is to equip Health Professions Trainees with the knowledge and skills required to champion safety within a VA Medical Center. Medical error is the fourth leading cause of mortality within the United States. The Advanced Fellowship in Patient Safety program equips future leaders across all professions and backgrounds to analyze and safeguard healthcare delivery.

As the Advanced Fellowship Coordinating Center (AFCC) for the AFPS program, the National Center for Patient Safety (NCPS) develops, administers, and evaluates the yearly non-accredited training experience. The one-year (July 1-June 30) fellowship is available at 6 different sites through 14 positions. The program is 1-year, running from July to June annually. Fellows are full-time VHA trainees and spend 100% of their time at VA medical centers (VAMC) with the expectations for clinical fellows to practice up to 25% time at the VAMC.

An essential element of the AFPS program is the diversity in education, professional experiences, and backgrounds. The fellowship recruits and educates a broad range of professionals in the science of patient safety and it continues to see a talented recruitment pool. This allows fostering of a cross-professional and collegial environment seeing both clinical and non-clinical backgrounds engaging in the inquiry and pursuit of safety excellence in the VHA both during the program and after graduation.

Graduates of the AFPS Program have the skills and education to support the VHA's safety culture, facilitate patient safety event reporting and investigation, engage in proactive risk assessment, and promote safe patient care. The AFPS Fellow position is an active position requiring high levels of engagement with local site staff and leadership to support the advanced fellows in their learning.

Fellows receive training in:

  • Quality Improvement
  • Safety Culture (Just Culture)
  • High Reliability Organizations
  • Measuring and Analyzing QI/PS metrics
  • Root Cause Analyses
  • Proactive Risk Assessments
  • Leading interdisciplinary healthcare improvement teams
  • Change Management
  • Educating healthcare staff in QI/P

Program Curriculum

The AFPS experience is captured through the completion of a summative program portfolio completed by each chief during their academic year consisting of:

  • Completing and presenting a year-long improvement project
  • Completing 5 Entrustable Professional Activities based on program milestones (similar to ACGME Milestones)
  • Attending National NCPS training in:
    • Team Training
    • Root Cause Analysis
    • Proactive Risk Assessment
  • Attending National curriculum including participation in:
    • July virtual orientation
    • "QI 101" rapid introduction to QI methods
    • Program-wide in-person conference
    • Biweekly online lecture series from national faculty experts
    • Biweekly small groups (called "Cadres")
    • Project works in progress sessions and office hours
  • Presenting their work to VA leadership

Patient Safety Fellowship Sites:

Ann Arbor, MI

  • Small town-major university setting; close connection to central office in DC
  • Patient safety leadership; policy
  • Development, implementation, and operation of system-wide patient safety programs
  • Alert & advisory processes
  • Access to patient safety database
  • Work with FDA, other government and regulatory agencies; work with manufacturers and standards organizations
  • Root Cause Analysis, Healthcare Failure Mode and Effect Analysis, Medical Team Training, Patient Safety curriculum for graduate medical education
  • High fidelity simulation for training and assessing teamwork skills
  • Contact:

Lexington, KY

  • Tertiary care center adjacent to the University of Kentucky Hospital
  • Opportunities to engage with executive leadership on meetings and projects
  • Open discussion of systems-issues by residents and fellows
  • Fellowship is onsite between two campuses
  • Participate in Root Cause Analyses, Healthcare Failure Mode and Effect Analyses, High Reliability Organization, LEAN, LEAN Tools
  • Work on projects to improve safety and care for our Veterans
  • Network among all services to learn about clinical and nonclinical hospital flows
  • Opportunities to engage with strategic planning groups
  • Fellows are aligned under the Quality, Performance, & Patient Safety Department
  • Development of team leadership skills
  • Contact: Elizabeth Lancaster:

Milwaukee, WI

  • Urban medical center on Lake Michigan
  • Multiple services including spinal cord injury center, long term care, physical rehabilitation, and Community Homes, with three community based outpatient clinics and a health care center serving a culturally and economically diverse group of Veterans
  • Major affiliates include College of Wisconsin with a Clinical Translational Science institute, Marquette University and University of Wisconsin-Milwaukee
  • State of the art simulation center and a long-standing, active in-situ simulation training program
  • Opportunity to be mentored by patient safety leaders in the organization and an interprofessional faculty team
  • Flexibility to focus on either the clinical application of patient safety concepts and/or education or research skills training
  • Make change or add to current knowledge and/or practice through an interdisciplinary facility-wide patient safety project
  • Contact: Florine Ndakuya-Fitzgerald:

Philadelphia, PA

  • Major city, major university (University of Pennsylvania) setting
  • Affiliation with Patient Safety Program at Hospital of the University of Pennsylvania and CHIPS (Center for Healthcare Innovation and Patient Safety) at Penn.
  • Concentration on use of simulation in patient safety and education; rotations at Penn's Clinical Simulation Center
  • Opportunity to enroll in courses at Penn's Center for Clinical Epidemiology & Biostatistics, Simulation Center, and School of Nursing
  • Contact: Gregg Lipschik:

Pittsburgh, PA

  • Human Factors emphasis, particularly as relates to medical device safety and information system design
  • Access to state-of-the-art medical simulation center for patient safety research and quality improvement projects
  • Close collaboration with clinical teams at the point-of-care in a high complexity academic VA medical center
  • Opportunities to lead inter-disciplinary teams in patient safety quality improvement projects
  • Mentored experiences in project management, proposal writing, and research
  • Contacts:

Tampa, FL

  • Polytrauma center of excellence
  • Research and research implementation
  • Preventing falls and fall related injuries in elderly
  • Studies related to safety of equipment
  • Safe Patient Handling and Mobility (SPHM)
  • Studies of interventions to improve gait and balance
  • Geriatrics (Community Living Center, GeriPACT, Home Based Primary Care, Hospice and Palliative Care)
  • Spinal cord injury
  • Mobility issues
  • Pressure injuries
  • Quality improvement
  • Evaluation methods
  • Implementation science
  • Contacts:

Articles on AFPS:

  1. Watts, Bradley V. MD, MPH; McKinney, Katherine MD, MS; Williams, Linda C. RN, MSI; Cully, Jeffrey A. PhD; Gilman, Stuart C. MD, MPH; Brannen, Judy L. MD, MBA. Current Training in Quality and Safety: The Current Landscape in the Department of Veterans Affairs. American Journal of Medical Quality 31(4):p 382-382, July 2016. | DOI: 10.1177/1062860615626276
  2. Watts, Bradley V. MD, MPH*†; Williams, Linda RN, MSI*; Mills, Peter D. PhD, MS*†; Paull, Douglas E. MD*; Cully, Jeffrey A. PhD‡; Gilman, Stuart C. MD, MPH‡; Hemphill, Robin R. MD, MPH*. Curriculum Development and Implementation of a National Interprofessional Fellowship in Patient Safety. Journal of Patient Safety 14(3):p 127-132, September 2018. | DOI: 10.1097/PTS.0b013e3182905e9c