1. Order from Chaos: Improving Quality of Care in a Resident/Faculty Practice Through Integrated Team Meetings
Jennifer Leiser, MD, Sonja Van Hala, MD, MPH, Bernadette Kiraly MD, Richard Backman, MD
Family Medicine Division, Department of Family and Preventive Medicine, University of Utah
Salt Lake City, UT, USA
Background
Results: Quality Indicators
Results: Team Development
Results: Participant Evaluations
The Team Development Measure (TDM) quantifies team effectiveness.
Administered in August 2009 and November 2011.
Quality indicators for our resident/faculty clinics were stagnant.
Barriers to quality improvement were lack of time to meet, insufficient training in clinic processes, and undeveloped teams.
Resident Continuous Quality Improvement (CQI) project teams lacked meeting time.
Most Helpful: Information on topics
Team meetings
Action oriented with practical solutions
Information on CQI process and quality
Personal story about disease impact
  Recommendations: Coordinate processes across teams
Follow up data to see impact and effect of work
Stay on time and complete agendas
Add patient perspective on quality
Methods
In July 2011 we implemented a monthly meeting to focus on quality and team building.
All faculty, residents and staff of the clinics participate. In November 2011 we measured quality indicators, measured effect on team process, and collected participant evaluations.
2009 mean score=50
2011 mean score=60 p=
Conclusions
Stages of Team Development
Stage
Score Range
Components Present
Solidification
Pre-Team
0 - 36
None to Building Cohesiveness - 1
Cohesiveness
In Place 2
Communication 3
Role Clarity 4
Goals & Means Clarity 5
Firmly In Place 6 7 8
Fully Developed
Everything
Preliminary conclusions after 4 months:
Quality indicators trending upward. It is too early to tell how much can be attributed to quality meeting.
We noted tendency for indicators to move in parallel. As teams paid more attention to the process for the month, they also addressed other processes. For example, working BPA for Pneumonia Vaccination led to working BPA for other preventive measures.
Team development shows improvement.
Participant evaluations generally positive.
Scholarly outcomes include a major grant submission and several anticipated conference presentations. 
Resident CQI Projects are now hardwired into our clinic process.
Meeting Schedule
8:00-8:50 Clinic Quality Update
Topic introduction
Personalized story
Present clinic level quality reports
Explanation of metrics
Best Practice Alerts (BPA)
9:00-9:30 Clinic Business Meeting
9:30-10:10 Clinic Team Meetings
Review individual provider data for team
Decide on team improvement goal
Create action plan with assignments
10:30-11:30 CQI Team Meetings
Resident-led projects linked to CQI curriculum
FOCUS-PDSA methodology
11:30-12:30 Practice Improvement Work Groups
Maternity Care Practice Enhancement
Chronic Pain Management
Resident Procedure Scheduling
In-basket Standardization
Interpretation: the teams have advanced from stage 2 to stage 4 during this time frame.
Monthly Topics
July: Pneumonia Vaccination
August: Diabetes
September: Influenza Vaccination
October: Breast Cancer Screening
November: Colon Cancer Screening
References and Acknowledgements
The Team Measure. Sacred Heart Medical Center, Accessed
This presentation was approved by the Institutional Review Board of the University of Utah, IRB
Special thanks to Rick Henriksen, M.D. and Katherine Fortenberry PhD for statistical assistance.
Special thanks to the staff and managers of the Madsen and Sugarhouse clinics for their participation and cooperation with this study.