Goals Today Overview of Embedded Quality Education in FM Residency Compare Modular vs. Experiential Models Lessons Learned Future : The GME Value Neighborhood
Why am I excited about teaching improvement methods in healthcare delivery?
“Every system is perfectly designed to obtain the outcomes it achieves.” Don Berwick, MD
What does Education in Quality Require? Investment: Time and Energy Teams Creativity and Safety Improvement Methodology Lean, Six Sigma, Model for Improvement, etc.
“ A goal without a method is cruel.” “Best efforts will not ensure quality, and neither will gadgets, computers or investment in machinery.” W. Edward Demming
Taguchi Shewhart Deming Juran Ishikawa Quality Improvement is not NEW.
Improvement Methodologies Historic: Edward Demming Model for Improvement Six Sigma Lean DMAIC Etc. 10
CQI Requirements for Residents ACGME: “Residents must be able to systematically analyze clinical practice data using quality methods and implement meaningful change. ” Accreditation Council for Graduate Medical Education. Common program requirements. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources /Common_Program_Requirements_07012011.pdf. Accessed December 4, 2013. 11
Teaching Improvement 2014 and beyond Modular Based Education Experiential Education 12
Comparing Teaching Methods Modular Fixed Content No Experiential Component Didactics : 22 hours of web- based instruction No Faculty/Stakeholder engagement Experiential Adaptable Content Experiential Didactics: 9 hours of faculty led discussion Faculty and Stakeholder engagement 14
Family Medicine: Improvement Curriculum Didactics: 9 Sessions, 1 hour on the mechanics of Improvement (July- April) Clinical Quality Meetings (CQM) July: – Dec: 1 hour sessions January – April : 30 min. sessions May & June : Team presentations
Overview : FOCUS - PDSA CitiCUSPDS Presentations July Aug Sept Oct Nov Dec Jan Feb Mar April May Intro Topic Aim CUSP Problem-solving, Overcoming barriers, PCMH, Leadership, etc. Intro Topic Aim QUALITY MEETING: Activities Seminar: Theory SS Scholarship break
Who leads the team? Third Year Residents with Faculty Advisor
Faculty Roles and Investment Leadership Didactic faculty Team Advisors Team members
Resident Roles R1: Observation/Participation R2: Team member R3: Team Leader 20
What do our residents gain? Stick Required GME experience Evaluations/Milestones NEW: Board Certification (Step4) Carrots Knowledge of Process analysis and Improvement methods Experience Leading a team Timely Feedback: Communication and Leadership Scholarship Opportunity PCMH Skills
What do learners in Modular Systems Acquire Knowledge of Process analysis and QI methods Experience Leading a team Timely Feedback on communication and leadership Scholarship Opportunity PCMH Skills 22
What about project Failures Learning Skillsets Continuous Learning: repeat cycles
Scholarship Prior to Experiential Quality Curriculum (2006-2010) 1 Resident National Presentation No Regional Resident Presentations No awards Lowest Ratings Patient Centered Medical Home Metrics in Quality After Experiential Quality Curriculum (2010-2014) 12 National Presentations 2 Regional Presentations 1 National Award (Pfizer QI award) Highest Ratings for Patient Centered Medical Home Metrics in Quality 25
Lessons Learned Faculty engagement is key to success Teams Time for team meetings Stakeholders support Umbrella IRB Citi Training for all residents Scholarship Calendar Build relationships 26
Future Goals GME Alignment Value Alignment Value = (Quality x Service) / Cost Operational Goals Resident CQI Aims Triple Aim (clinical operations, education translational scholarship) 27
Value improvement methodology at UUHC 1.Project Definition 2.Baseline Analysis 3.Investigation 4.Improvement Design 5.Improvement Implementation 6.Monitoring Lean 66 PDSA