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

2. 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

3. 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

4. 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

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

6. 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

7. 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.

8. 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

9. 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

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

11. 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)

12. 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

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

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

15. 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)

16. 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.

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

18. 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

19. 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.

20. 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

21. 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

22. 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