A Blueprint for Alignment

Transcription

1 A Blueprint for Alignment Engaging Residents in the Quality and Safety Mission of Penn Medicine PJ Brennan, MD Chief Medical Officer, UPHS Jennifer S. Myers, MD Director of Quality and Safety Education Perelman School of Medicine, Penn

2 PENN Medicine TRUSTEES OF THE UNIVERSITY OF PENNSYLVANIA PENN Medicine Board President of the University University EVP/SOM Dean School of Medicine Health System Clinical Components Clinical Practices of the University of Pennsylvania (CPUP) Academic & Research Clinical Hospital of the University of PA (HUP) PENN Presbyterian Medical Center (PPMC) Pennsylvania Hospital (PAH) Clinical Care Associates (CCA) Penn Home Care and Hospice Services (PHC&HS) 2

3 Initial Imperatives of the Blueprint for Quality UPHS Blueprint for Quality and Patient Safety UPHS overarching quality goal is to reduce mortality and reduce 30-day re-admissions. Four Imperatives Transitions in care Reduce variations in practice Priority Actions Transition planning Medication management Reduce hospital-acquired infections Reduce medication errors Coordination of care Interdisciplinary rounding Accountability Unit clinical leadership 3

4 To bring clinical strategy to the frontline, we established local leadership on each hospital unit Three-Way Partnership Manages Quality on the Hospital Units Physician Leader and Nurse Leader are paired at the hospital unit level with a Project Manager for Quality who brings data and project management skills. We call these trios UBCLs, for Unit Based Clinical Leadership. 4

5 FY12 HUP quality & safety accomplishments Across 80,000 discharges and >2M ambulatory visits: Observed to expected mortality improved by 5%, after 40% reduction from HUP ranks second in mortality among US News Honor Roll hospitals. Hospital associated pressure ulcers decreased by 40%. Urinary Tract Infections decreased by 30%. Blood stream infections: >95% reduction since FY06 (more than 400 per year). Ventilator associated pneumonia: >95% reduction. Created a UPHS-wide health-care acquired infection (HAI) award to recognize units that have gone a significant period (e.g. 1,000 days) of time without: Central Line Bloodstream Infection (CLABSI) Ventilator Associated Pneumonia (VAP) Urinary Tract Infection (CA-UTI) 5

6 Penn Medicine Blueprint for Quality and Patient Safety Penn Medicine will eliminate preventable deaths and preventable 30-day readmissions by July 1, 2014 Imperatives 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 Priority Actions Always events - strive to provide perfect care Implement clear lines of accountability that span inpatient and ambulatory environments Provide consistent and thorough communication with families & patient regarding plan of care Increase patient and family involvement in UPHS forums that address issues relevant to quality, safety and service excellence Enhance patient-provider partnership through better exchange of information Ensure all UBCLs implement redesign care processes related to: - Risk stratification - Interdisciplinary rounding - Discharge hand-off to outpatient care Eliminate variations in care processes where evidence exists Balance conformity in practice with needs for personalized care Set goals that are positive and proactive Strengthen organizational capacity and capability for continuous improvement Increase involvement of house staff in quality, safety and service excellence efforts 6

7 Timeline for Quality and Safety Education ACGME introduced new competency-based educational standards ACGME New Duty Hour Requirements with expectations for integrating residents in quality and safety programs IOM Reports IOM commissioned a report focused on GME and Safety. Focused on duty hours, handoffs, and safety education ACGME introduces the New Accreditation System based on resident milestones and Entrustable Professional Activities 7

8 Integrated or Not? Operational Quality/Safety Goals: Trainees as Front line providers Educational Quality/Safety goals: Trainees as learners Residents as Common End Point 8

9 A Blueprint for Quality and Safety Education Mission Statement Create an integrated approach to quality and safety education that is aligned with the goals of Penn Medicine. How do we get there? 9

10 Problems 1. Educational experiences in quality and safety few and far between 2. Not enough faculty who are confident and skilled in teaching quality and safety 3. Few opportunities for residents to contribute to or lead quality and safety initiatives. 10

11 Fragmented Education in Quality & Safety Undergraduate Medical Education Graduate Medical Education CME: Faculty Development Not enough Educational Activity A little more Next to none Where education exists, it is not coordinated or executed along the continuum 11

12 Cohesive Education in Quality and Safety Undergraduate Medical Education Graduate Medical Education Continuing Medical Education Students Learn Foundations & Appreciate Clinical Applications Residents Re-Taught & Demonstrate Competency Faculty Practice & Maintain Competence Quality & Safety Educators 12

13 Taking On The Faculty Development Problem Goal: Competent and engaged faculty ready to teach quality and safety to residents Develop infrastructure for institutional faculty development Align what the residents are taught with our local needs and priorities for healthcare quality 13

14 A Menu of Content Areas for Faculty Development Handoffs and Transitions Health Information Technology Mentoring Residents in QI projects Patient- Centered Care Interprofessional Teamwork and Communication Safety Culture and Reporting Value & Cost Conscious Care Resident Supervision Evidence-Based Medicine Forum: Half-day conference in education on Safe Transitions of Care Target audience: Residency program faculty & Quality/safety faculty Methods: Provide a curriculum framework and a toolkit of resources Outcome: all departments teaching and assessing handoff skills 14

15 Problems 1. Educational experiences in quality and safety few and far between 2. Not enough faculty who are confident and skilled in teaching quality and safety 3. Few opportunities for residents to contribute to or lead quality and safety initiatives. 15

16 How Do We Identify & Train Future Leaders in Health Care Improvement? Physician Leaders in Quality and Safety Advanced Training and research experiences Graduate Medical Education Undergraduate Medical Education 16

17 Building the Pipeline A Residency Track in Quality A Fellowship in Quality and Safety Science 17

18 A Residency Track in Quality Identify the pipeline Didactics & Experiences Generate engagement UBCL Integration Mentorship Build Capacity Capstone QI Project Influencing faculty, nurses and peers 18

19 A Fellowship to Advance Quality Science 2 Year Fellowship Program Research Training Masters in Health Policy Thesis Project Research Mentors Quality & Safety Training Quality & Safety Course(s) Experiences Quality/Safety Mentors Training History AY 09-10: 1 nephrology fellow AY 10-11: 1 surgery resident AY 11-12: 1 infectious disease fellow 1 anesthesia faculty AY 12-13: 1 endocrine fellow 1 pediatric cardiology fellow 19

20 Penn s Housestaff Quality and Safety Council* Discussion of quality/safety concerns reported by residents or that relate to residents Resident led, hospital supported improvement projects Handoff Communications Who s on Call IT Communications Communication. Engagement.Alignment *Fleischut, et al. Am J Med Qual,

21 Changing Culture Tools Behavior Advanced Training Pathways in Quality Faculty Development Programs Housestaff Quality & Safety Council? Attitudes Culture Hidden Curriculum Informal Curriculum 21

22 Next Phase of our Educational Journey Engage even more residents and faculty Defining minimum competency in quality and safety for all students and residents. What? When? How to measure? Increased focus on interprofessional teaching and learning experiences 22

23 Acknowledgements Collaborators and Supporters at Penn Gail Morrison MD Lisa Bellini MD Jeffrey Berns MD Pat Sullivan PhD Richard Shannon MD Kathleen Burke RN PhD Joshua Metlay MD PhD Kathy Shaw MD MSCE Neha Patel MD Caroline Reinke MD Jason Itri MD PhD Josiah Macy Jr. Foundation 23