1. An Embedded Quality Improvement Curriculum : Lessons learned from Family Medicine Residency Program Directors’ Retreat September 25, 2014

2. Embedded….. –b ……….to make something an integral part 2

3. This is not about Duty Hours….

4. Goals Today  Overview of Embedded Quality Education in FM Residency  Compare Modular vs. Experiential Models  Lessons Learned  Future : The GME Value Neighborhood

5. Why am I excited about teaching improvement methods in healthcare delivery?

6. “Every system is perfectly designed to obtain the outcomes it achieves.” Don Berwick, MD

7. What does Education in Quality Require? Investment: Time and Energy Teams Creativity and Safety Improvement Methodology Lean, Six Sigma, Model for Improvement, etc.

8. “ 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

9. Taguchi Shewhart Deming Juran Ishikawa Quality Improvement is not NEW.

10. Improvement Methodologies Historic: Edward Demming Model for Improvement Six Sigma Lean DMAIC Etc. 10

11. 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[1].pdf. Accessed December 4, 2013. 11

12. Teaching Improvement 2014 and beyond Modular Based Education Experiential Education 12

13. Model for Improvement Overview

14. 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

15. 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

16. 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

18. Who leads the team? Third Year Residents with Faculty Advisor

19. Faculty Roles and Investment Leadership Didactic faculty Team Advisors Team members

20. Resident Roles R1: Observation/Participation R2: Team member R3: Team Leader 20

21. 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

22. 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

23. What about project Failures Learning Skillsets Continuous Learning: repeat cycles

25. 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

26. 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

27. Future Goals GME Alignment Value Alignment Value = (Quality x Service) / Cost Operational Goals Resident CQI Aims Triple Aim (clinical operations, education translational scholarship) 27

28. Value improvement methodology at UUHC 1.Project Definition 2.Baseline Analysis 3.Investigation 4.Improvement Design 5.Improvement Implementation 6.Monitoring Lean 66 PDSA

29. Questions? Oath