The Clinical Learning Environment Review (CLER) Program. Background

Transcription

1 Accreditation Council for Graduate Medical Education The Clinical Learning Environment Review (CLER) Program November 2013 Background ACGME Task Force Linked adherence to duty hours policies to professional responsibilities for patient safety and healthcare quality Recommended assessment in the form of a Sponsor Visit Program National Advisory Committee (selected recommendations) Use first round of visits and reports solely for baseline data and learning not an accreditation visit Include full-time staff and volunteer peers as site visitors Establish process for site visit, evaluation, and feedback 1

2 CLER Focus Areas Patient Safety Duty Hours Fatigue Management Healthcare Quality Healthcare Disparities Supervision Transitions of Care Professionalism Program Components Site Visit Program Evaluation Committee Faculty/Professional Development 2

3 Program Components Site Visit Program Evaluation Committee Faculty/Professional Development Clinical Learning Environment Review (CLER) Program First cycle of visits Used solely for feedback, learning, and establishment of baseline information for sponsoring institutions, the Evaluation Committee, and IRC Exception(s): identification of potential egregious violations involving threats to patient safety or resident safety/well being Planned to result in the Evaluation Committee s dissemination of salutary practices 2012 Accreditation Council for Graduate Medical Education (ACGME) 3

4 Clinical Learning Environment Review (CLER) Program First Cycle Alpha testing June-Aug 2012, Beta testing Sept 2012-present 380+ Sponsoring Institutions with multiple programs One participating site per sponsoring institution CLER Program 5 key questions for each site visit Who and what form the hospital/medical center s infrastructure designed to address the six focus areas? How integrated is the GME leadership and faculty in hospital/medical center efforts across the six focus areas? How engaged are the residents and fellows? How does the hospital/medical center determine the success of its efforts to integrate GME into the six focus areas? What are the areas the hospital/medical center has identified for improvement? 4

5 CLER Site Visit Schematic Flow Walk Around II Resident Meeting Walk Around I CPS/CQO Core Faculty Walk Around III CPS/CQO Program Directors CEO& Senior Leadership Meeting Foundational Learning Exploration Foundation & Inquiry Review, Clarification & Feedback CEO & Senior Leadership Meeting Future visits may include interviews with patients. Three Phases of the Visit Site visit team huddles occur between some interviews. Longer Term Challenges Sampling Multiple Participating Sites per SI Visits to Single Program Sponsoring Institutions Visits to special/unique participating sites, e.g., VA, specialty-care sponsoring institutions Building in additional perspectives (e.g. patients, governance, D-Suite) 5

6 Program Components Site Visit Program Evaluation Committee Faculty/Professional Development CLER Evaluation Committee Includes national expertise in GME and the six focus areas Co-Chairs: James Bagian, MD and Kevin Weiss, MD Meets quarterly Responsible for evaluating site visit reports/responses and providing feedback 6

7 CLER Evaluation Process* CLER Sponsoring Institution Site Visit (Cycle I n=380+) Site Visit Oral Report 1 initial feedback Site Visit Report Institutional response (optional ) Possible egregious violation 3 Copy of report sent back to institution, allow for response 2 CLER Program Staff Preparation for Committee Review (Completeness and attachment of any institutional response) Cycle I: To IRC (aggregate, de-identified) Committee Report (final) CLER Evaluation Committee Review * Approved by CLER Evaluation Committee 10/2012 CLER Process Map Ver 2.1, CLER in the context of NAS CLER evaluation is based on expectations not requirements CLER is designed as a formative learning process for both the institutions and ACGME Collective knowledge from CLER will likely inform future institutional requirements 7

8 Program Components Site Visit Program Evaluation Committee Faculty/Professional Development Faculty/Professional Development ACGME in a convening role Exploring and encouraging alignments and collaborations among national efforts: AAMC, AHME, AIAMC, IHI, AHA, ACPE, ACMQ, OPDA and others Addressing inter-professional education across the UME/GME continuum Includes development of educational initiatives aimed at executive leadership 8

9 CLER PATHWAYS TO EXCELLENCE: A GUIDANCE DOCUMENT GME Engagement in Patient Safety (Example from Draft Pathways Document) Reporting of adverse events/near misses Education on patient safety Learning environment culture of safety Resident /fellow experience in patient safety investigations and follow-up Clinical site monitoring of resident/fellow engagement in patient safety Clinical site monitoring of faculty engagement in patient safety Resident and fellow training in disclosure of patient safety events 9/2013 9

10 Example of Steps in CLER Pathways (Patient Safety) Group Meetings Residents, fellows, faculty and other clinical staff (nurses, pharmacists, etc.) know how to report patient safety events at the clinical site. Walking Rounds Few Nearly All 9/2013 CLER Pathways to Excellence Guidance document Developed by CLER Evaluation Committee Initially based on expert input, evidence, and early experiences from CLER program Will evolve into empirically driven set of guidance statements based on what is possible Serve as basis for comparative feedback and-- when used in aggregate-- provides national measures of progress 9/

11 CLER Pathways to Excellence Planned roll-out of document Informal introduction of document between now and launch Launch in late January to early February Basis of next major CLER visit protocol revision 11