Date of Submission


Document Type



Doctor of Education




Quality Assurance, Anesthesia, Consultation, Competency, Training, Complex Adaptive System, Complexity Theory, Plan-Do-Study-Act Cycle


The absence of quality assurance in training clinicians to perform pre-anesthesia consultations at a Canadian university is the Problem of Practice addressed in this Organizational Improvement Plan. This competency requires learners to apply their anesthesia knowledge to take medical histories; perform physical examinations; diagnose anesthetic risks; and generate anesthesia plans. Random chart audits of many learners identify deficiencies and suggest inconsistent training of this competency. This Organizational Improvement Plan analyzes the anesthesia program’s organizational context to be a complex adaptive system; organizational structure to be a hierarchy; and organizational state to be static. Through the paradigms of complexity theory, interpretivism, critical theory, and pragmatism, this proposal describes how adaptive, enabling, and administrative leadership strategies will (1) improve competency training of pre-anesthesia consultations; (2) build capacity of the anesthesia program’s stakeholders; and (3) foster a collaborative culture. An Integrated Framework of the Change Path Model and the Modified Plan-Do-Study-Act Cycle will serve to implement change in this organization. The research and recommendations offered in this work can be adapted for use in other clinical programs aiming to improve competency training.