Karen Bos San Mateo Residency QI Course September 17, 2013 Introduction to QI Karen Bos San Mateo Residency QI Course September 17, 2013

Outline Pre-test of QI knowledge Introduction to QI course Break into groups to discuss sample scenarios and share results with the whole group Critical thinking activity: What doesn’t work? Wrap-up and review

Outline Pre-test of QI knowledge Introduction to QI course Break into groups to discuss sample scenarios and share results with the whole group Critical thinking activity: What doesn’t work? Wrap-up and review

Outline Pre-test of QI knowledge Introduction to QI course Break into groups to discuss sample scenarios and share results with the whole group Critical thinking activity: What doesn’t work? Wrap-up and review

Introduction to qi course Why are we having this course? Syllabus Brief introduction to QI methods

What does the qi course offer residents? Chance for self-reflection and critical thinking Opportunity to improve a challenging aspect of our work Possibility of making real improvements in the way that BHRS delivers patient care Research/publication opportunities

ACGME QI REQUIREMENT Resident involvement in QI is now mandated by the ACGME as a component of resident education: ACGME competency in Practice-based Learning and Improvement: Residents expected to meet a set of goals including “systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement.” ACGME CLER (Clinical Learning Environment Review) program emphasizes the responsibility of the institution in integrating resident education into quality and safety initiatives. http://www.acgme.org/acgmeweb/Portals/0/PDFs/commonguide/IVA5c_EducationalProgram_ACGMECompetencies_PBLI_Explanation.pdf

QI and Scholarly Activity Several opportunities for scholarly activity based on work in this class BHRS Community Project Poster Day Grand Rounds Workshops/posters at national or regional meetings Publications in journals “Publication” on residency website

Goals of the course After completion of this course, residents will: Be able to explain the reasons hospitals are improved in quality improvement and the contribution that QI methodology can make to the health care system Be able to outline the steps in a PDSA quality improvement cycle Be able to identify factors that enhance the success and sustainability of quality improvement projects Initiate, develop, and complete a quality improvement project Share the results of their quality improvement projects in a scholarly way

Timeline Course consists of ten sessions, each lasting from 3:45-5:00

Block 1: Introduction to QI Session #1: Introduction to QI (today) Session #2: QI at San Mateo/BHRS (Guest speaker: Lilian Montalvo, BHRS quality liaison)

Block 2: Implementing QI projects Session #3: Identifying Projects Session #4: Process Mapping and Intervention Session #5:Lecture on the LEAN Initiative at SMMC/Project work time Session #6: Lecture on the Naltrexone PIP/Project work time Session #7: TBD/Project work time Session #8: TBD/Project work time

Block 3: Results, Presentation, review Session #9: QI Project Results and Review Session #10: San Mateo Residency Community Project Day

Curriculum Take home points This is a chance for us to be creative, think critically, and improve our program

Focus on QI Current focus on quality of U.S. health care and the need for quality improvement as part of health system reform 2005: Patient Safety and Quality Improvement Act passed which focused on preventing medical errors 2010: Affordable Care Act emphasis on improving quality of care Introduction of a “culture of quality” in medicine (Warraich article)

Definition of QI Quality improvement: a method for ensuring that all the activities necessary to design, develop and implement a product or service are effective and efficient with respect to the system and its performance.

PDSA Cycle Courtlandt CD et al. Model for improvement – Part 1: A framework for health care quality. Pediatr Clin N Am 56;2009:762.

Implementation of pdsa cycle Quality improvement project: Identify an issue Build a team to address it Define the problem Choose a target Test the change Reconsider or extend the improvement efforts

Choosing “SMART” aims Specific: aim should be clearly stated, include numerical goals Measureable: consider baseline data and how to measure progress or determine project outcomes Achievable: less is more! Feasible, focused project Relevant: residents are in a good position to identify relevant, meaningful clinical challenges Time-framed: set a realistic time frame Arbuckle MR and Cabaniss DL. Columbia Quality Improvement Curriculum.

Outline Pre-test of QI knowledge Introduction to QI course Break into groups to discuss sample scenarios and share results with the whole group Critical thinking activity: What doesn’t work? Wrap-up and review

Outline Pre-test of QI knowledge Introduction to QI course Break into groups to discuss sample scenarios and share results with the whole group Critical thinking activity: What doesn’t work? Wrap-up and review

Outline Pre-test of QI knowledge Introduction to QI course Break into groups to discuss sample scenarios and share results with the whole group Critical thinking activity: What doesn’t work? Wrap-up and review