Teaching & Mentoring Residents & Fellows in Quality Improvement
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Transcript of Teaching & Mentoring Residents & Fellows in Quality Improvement
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Teaching & Mentoring Residents & Fellows in Quality Improvement
GME SymposiumOctober 3, 2014
Curriculum Development & Planning SlidesJennifer Myers MD
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What is the ACGME Looking for?“Top” of the Pyramid
Miller’s Pyramid for Learner Assessment
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“Milestone” ReportingA Sample from a QI Milestone Reporting Worksheet
Applies performance improvement methodologies
Participates in process improvement to optimize ED practice
#20. PBLI: Participates in performance improvement to optimize ED function & pt care
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Yeah…But What About My Specialty?
General Surgery • The resident performs basic steps in a QI project
Internal Medicine & Medicine Subspecialties• Actively engages in quality improvement initaitives• Demonstrates the ability to apply common principles & techniques of
QI to improve patient care for a panel of patients
Radiation Oncology• Able to define and construct process & outcomes measures of quality• Designs & completes a QI project
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Common Questions • Do trainees need to be “doing” QI every year of
their training?– NO
• Does each trainee need to lead their own separate project?– NO
• How much active participation does each trainee need to have in the QI project?– We don’t know. The ACGME has not defined this…
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Curriculum Development Process
Kern’s 6-Steps Problem Identification &
General Needs Assessment Needs Assessment of Targeted Learners Goals & ObjectivesEducational StrategiesImplementationEvaluation & Feedback
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Step By Step Approach
Educational StrategiesImplementation
Step 3:Project
Management
Step 2:Project
Selection
Step 1:Make a Plan
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Step By Step Approach
Educational StrategiesImplementation
Step 1:Make a Plan
Step 2:
Step 3:
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Step 1: Make a Plan(aka: Educational Strategies)
• Who will teach the content?– Teacher Options:
• You!• You + one of us to co-teach & facilitate
• How?– Format Options
• Teach content all at once • Flipped Classroom• Teach content piecemeal for just-in-time learning & use• Think about involving non-housestaff in the activity (faculty, nurses, other
staff)
• When?
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Step 1: Make a Plan(aka: Educational Strategies)
• What level of learner will you involve?
• Who will guide them longitudinally through the project?
• Who is not here that you can potentially enlist to help?
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Step 1: Make a PlanProject Organization Options
Option 1: Several Trainees (2 -10) = One “Program” Project
Option 2: Many Trainees (>10) = One project “handed off” or more 2 or more program projects
Option 3: One Trainee = One Project
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OK – Make a Plan!
10 minute Activity
Take a few minutes to fill out the top of the worksheet grid.
If you are here with others in your program, you should work on it together
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Step By Step Approach
Educational StrategiesImplementation
Step 1:Start to Plan
Step 2:Project Selection
Step 3:
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Step 2:Project Selection
• Perhaps the most important decision you will help your trainees to make
• Think small and doable, not big and complex – SCOPE
Think about the “A” (ACHIEVABLE) in SMART goal
• Look for projects that align with division, departmental, hospital, or clinic quality goals– Think about the “R” (RELEVANT) in SMART goal
• A project that is just starting in your division/dept that the trainees can join
• Something that interests the residents or fellows
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Step 2: Project Selection
“ Top-Down” vs “Bottom-Up” Approach to Project Selection
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Step 2: Project Selection
• Who needs to approve? – Division/Department leadership– We in CEQI are working on a process for this
• Who needs to be informed?– Stakeholder Analysis: develop a communication plan
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Step By Step Approach
Educational StrategiesImplementation
Step 1:Start to Plan
Step 2:Project Selection
Step 3:Project
Management
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Assume trainees know nothing (and I mean nothing)
about managing a project and running meetings
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You Will Need to Make Connections for the Residents & Fellows
One success factor for trainee QI projects is faculty mentors who have local system knowledge and
deep connections within the organization*
Ogrinc G, et al. Academic Medicine, 2014
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What are we connecting the trainees to?
Residents & FellowsInfrastructure
Data
People in our Organization
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Is there 1 or more residents or fellows who have an interest in this area?
• Consider having them lead or co-lead the project• Opportunities for them to get additional training
– Healthcare Leadership in Quality Track• Director: Neha Patel (table #6)
– CHIPS Fellowship• Director: Jen Myers (table #1)
– Performance Improvement Training (PIIA)• Chris Klock (table #7)
– Masters course in QI methods (fall semester)• Kathy Burke & Jen Myers
– Have them attend our workshops/office hours with you
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Proposed Timeline for Penn GME QI Curriculum
Today Oct Nov Dec Jan Feb Mar Apr May->
Planning X
Select a QI project area X
Problem Statement X
Current Condition (baseline data, observation, process maps)
X
Root Causes(5 whys, pareto, fishbone)
X
Target Condition & Measures (SMART aim)
X
First Test of Change (PDSA cycle)
X
2nd, 3rd Test of Change;Eventually make it “Standard Work”
X
= STOP! DID YOU DO THE “APPROVE” & “INFORM” STEPS?
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Resources
• People – All of us– CEQI Staff in your division/dept/unit
• Tools – Everything from today & more is up on the GME website
• More Training Opportunities– QI “Office Hours”….more to come!– Performance Improvement in Action Curriculum– Graduate School Course in QI (fall semester)– Reading List (annotated bibliography in folders)
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GME Quality & Safety On-Line Toolkit
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Everything we have shown you and talked about today is here
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Data Resources for Quality(readily available online)
Inpatient Quality Datamart
- Healthcare Associated Infections
- Patient Experience Scores (HCAHPS)
- Patient Safety Indicators- Readmissions- CMS Core Measures- Mortality
Ambulatory Analytics- Patient Access
- Call Volume- New Patients Seen w/i 2 wks- Visit Data
- Patient Experience- Preventative Care
- Cancer screeneing- Tobacco screening/counseling- Vaccinations
- Diabetes Care Indicators
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Other Data Resources
- Patient Experience – Mike Anderson- Administrative Data – Jeff Rohrbach- Cost Data – Chad Johnston- Patient Safety
- Penn Medicine Safety Net – Luther Kay- Safety Culture Survey Data – Venkat Panchmanadam
- Discrete SCM/EPIC data - Penn Data Store request form- GME & CEQI working together on this
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