A Quiz. I am comfortable going to any healthcare provider or hospital in my city/town.
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- Meagan Richards
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1 A Quiz I am comfortable going to any healthcare provider or hospital anywhere in the country. I am comfortable going to any healthcare provider or hospital in my city/town. I am comfortable going to my hospital or any healthcare provider in my institution.
2 QUESTION: Should you consider yourself a high quality physician if you train in a health care system that is not systematically trying to improve the value of care it provides? Larry Casalino Yes No What?!
3 The Good Doctor Past Encyclopedic Knowledge Independent Always Available Master of Rescue Care Present Solid Fund of Knowledge Gatherer of Information Team Player Embrace Quality, Safety, & Public Reporting Evidence-based Patient-centered Swensen SJ, et al. N Engl J Med
4 How Do We Get There? What Do We Value & Teach? Honesty, openness, transparency and disclosure Teamwork & accountability across disciplinary lines Commitments to recognize and address anomalies in professional behavior Continual pursuit of safety in healthcare Continual reduction in waste Patient-centeredness in all things Awareness of economics, healthcare costs, and social stewardship Berwick and Finkelstein, Acad Med, 2010
5 Quality & Patient Safety Graduate Medical Education Finally Coming Together Jennifer S. Myers MD December 5, 2014
6 Timeline for Quality and Safety Education ACGME introduces a competency framework for residency training; understanding systems are now part of the required curriculum ACGME introduces New Duty Hour Requirements with more quality and safety training expectations ACGME Next Accreditation System IOM Reports 2003 IOM commissions a report on GME and safety 2014 IOM Report on GME Funding
7 A Call to Action 100 Percent of Residency Programs Teaching the Following Topics; National Sample Patient Safety Quality Improvement Inpatient Handoffs Discharge Transitions High Value Cost Conscious Care QSEA 2012 QSEA 2013 QSEA 2014
8 Penn is Not That Much Better! Patient Safety Quality Improvement Inpatient Handoffs Discharge Transitions QSEA 2012 QSEA 2013 QSEA 2014 Penn Fall 2013 High Value Cost Conscious Care
9 Barriers: Hidden Curriculum Lack of faculty expertise & buy-in Time Change QI can be seen as a bad word QI Incentives: Public opinion External Regulations GME funding OUR PATIENTS
10 graduate medical education must include training and active participation in quality and safety initiatives by every resident physician. Dr. Tom Nasca; JAMA 2013 ACGME has the aspirational goal of demonstrating to the public that America s teaching hospitals and institutions are safe and of high quality.
11 MILESTONES: Demonstrate Competency in Quality & Safety Clinical Learning Environment Review Program: Engage Residents & Faculty in Institutional Quality & Safety Efforts
12 Milestones for Quality & Safety Patient Care PBLI (QI) SBP (Safety) Ready for Unsupervised Practice
13 Clinical Learning Environment Review Program (CLER) Six Key Focus Areas for CLER: 1. Quality Improvement 2. Patient Safety 3. Handoffs & Transitions 4. Supervision 5. Professionalism 6. Duty Hours/Fatigue Management Key Questions: How engaged are the residents and fellows? How integrated is the GME leadership and faculty in the hospital/medical center efforts across the six focus areas?
14 University of Pennsylvania Health System Acknowledgements: PJ Brennan MD; CMO Jeffrey Berns MD; DIO Pat Sullivan PhD; VP QI/PS Neha Patel; MD MS Lisa Bellini MD; Vice-Dean Faculty Affairs Tertiary care health system in Philadelphia (3 hospitals) 789 beds at our primary academic teaching hospital 78 accredited GME programs 1147 housestaff Department of Clinical Effectiveness & Quality Improvement (CEQI) National reputation for quality and safety
15 Penn s Blueprint for Quality & Patient Safety (2009) Penn Medicine Blueprint for Quality and Patient Safety Penn Medicine will eliminate preventable deaths and preventable 30-day readmissions by July 1, 2014 Imperatives Priority Actions Accountability For Perfect Care Patient And Family Centered Care Transitions In Care/Coordination Of Care Reducing Unnecessary Variations In Care Provider Engagement, Leadership, And Advocacy Always events - strive to provide perfect care Implement clear lines of accountability that span inpatient and ambulatory environments Provide consistent and thorough communication regarding plan of care Increase patient and family involvement in UPHS forums and integrate patient feedback into clinical and service improvement efforts Redesign clinical processes to ensure that patients and their information are safely transitioned from one setting of care to another Eliminate variations in care processes where evidence exists Balance conformity in practice with needs for personalized care Improve the value of our health care processes and outcomes Strengthen organizational capacity and capability for continuous improvement Increase involvement of housestaff in quality, safety and service excellence efforts Increase involvement of house staff in quality, safety and service excellence efforts
16 The Beginning of Our Story Identifying & Engaging the Residents and Fellows Who Wanted to be Leaders and Change Agents for Healthcare Improvement Rogers, Diffusion of Innovation Curve
17 Healthcare Leadership in Quality Track Didactics: Year 1 (August2014) Year 2 (1 week) Process Improvement In Action Training UBCL teams (Ambulatory, CICU, CCU, MICU, Founders 12/14, Oncology) IT (mobile health, clinical decision support) Core Curriculum Quality Improvement On the Front Line Capstone QI Project Mentorship QI Operation Project QI Research Project 2 years timeline Abstract (minimum requirement) UBCL physician leaders Process improvement specialist Quality/safety leaders QI research mentors Established in Patel N, Brennan PJ, et al. Academic Medicine 2014
18 Housestaff & Advanced Practitioner Quality Council Department of Clinical Effectiveness & Quality Improvement Housestaff & Advanced Practitioner Quality Council A forum for QI problemsolving with residents from diverse departments Connect health system quality priorities with resident/ap ideas & leadership Annual QI Project Established 2011 at UPHS
19 The Middle of our Story: Reaching the Majority Rogers, Diffusion of Innovation Curve
20 What Do The Residents Think? TIME CULTURE Limited time in day for non clinical tasks Apathy / learned helplessness / lack of confidence in ability to affect change Competing learning priorities Limited protected time for QI Lack of Formal Curriculum Lack of awareness of back end of QI/PS processes Little or no role modeling by attending or upper year residents Fear of repercussions / punitive nature of reporting Transient nature of residency: residents float from floor to floor; hospital to hospital Lack of interdepartmental, interdisciplinary interaction Lack of Resident Engagement in Quality & Safety Activities Large, difficult system to change Lack of feedback on Safety Net Reports EDUCATION/ AWARENESS STRUCTURE Created by Penn Healthcare Leadership in Quality Track Residents (n=24); August 2013
21 Conceptual Framework for Resident Engagement in Quality & Safety Culture Infrastructure Inter- Professional Collaboration Resident & Fellow Engagement in Quality & Safety Health System- GME Alignment Educational Resources Faculty Development A Tess & JS Myers
22 Daily supervision, role modeling, & practice enforces local quality/safety culture Shared Responsibility: New Relationships, Roles, and Work Frontline Faculty & All Staff Hospital Quality Office Trainees Infrastructure, Shared Work Plan GME Office Oversight Centralized resources Curriculum development, Teaching, Mentorship Core QI/PS Faculty A Tess & JS Myers
23 Penn s GME Quality/Safety Efforts Culture Safety Reporting Campaign FOCLE Walk Rounds Educational Resources Quality & Safety Toolkit on GME website Video-based Orientation Module to Introduce Penn s Culture of Quality & Safety Faculty Development Faculty Development as much as humanly possible! Interprofessional Collaboration RN/NP involvement in HS Council Partnering with Nurses for svc orientation Infrastructure Associate DIO for QI/PS new position Quality/Safety Educator(s) in each department Hstaff Quality/Safety Leadership Council Healthcare Leadership in Quality Track New relationships with Quality Data managers to make data more accessible to programs and trainees Health System GME Alignment Associate DIO for QI/PS sits in both worlds Shared QI-CLE Dashboard with Outcome measures to focus our work measure progress
24 Thank You
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