1. A Collaborative Quality Improvement Curriculum for Internal Medicine Residents and Masters of Public Health Students: The Lean Way
Gouri Gupte PhD, School of Public Health
Charlene Weigel MD, Department of Medicine, Mount Auburn Hospital
Winnie Suen MD, MSc, Department of Internal Medicine, Section of Geriatrics, Boston Medical Center

2. Exercise: Step 1: Please watch the video
Step 2: Please arrange the index cards (steps) in chronological order
Step 2: Identify those steps that are not necessary to the process.

4. GOALS GOALS COMPETENCIES MET
Improve the quality and cost-effectiveness of healthcare delivery and QI education in multiple clinical microsystems at BMC
Systems-based practice
- Learner will gain an appreciation of the complex system of health care and how to approach improving one piece of it.
Practice-based learning and improvement
- Leaner will use self-reflection of their own practice in order to use this as a way to make improvements
Use Lean methodology principles to create a Quality Improvement curriculum for interdisciplinary teams.
- Learner will gain knowledge about Lean Methodology, creation of process flow chart, how to identify ways to improve a system
Interpersonal and Communication Skills
- Leaner will gain skills in working with an interdisciplinary team. Combine with MPH students
Professionalism
- Learner will be accountable to and work effectively with teams
- Learners will respect the interdisciplinary staff that they will be working with to gain hands on experience in a QI project
Value of collaborative quality improvement (QI) work
Engaging the learners
Allow for hands-on QI experiences
Provide real world experiences in QI
Positively influencing the QI culture of Boston Medical Center
Encouraging learners to work towards understanding quality and cost-effectiveness within a resource challenged, safety-net healthcare delivery system.

5. (Clinical Knowledge)
Residents at Boston Medical Center
(Quality improvement consultants)
Public Health Students at Boston University

6. Schedule

7. Session 1: Intro to QI at BMC

8. Session1 cont’d: 4 pods x4 groups = 16 projects

9. Projects: Identified by the students
Outpatient Medication Review
Improving inpatient workflow
Inpatient Medication Review
Improving team roles in Emergency response team
Seeing patients efficiently in clinics
Improving notification of when labs aren’t drawn
Patient awareness of members of the inpatient team (improved patient satisfaction)
Improving prerounding experience
Eliminate number paging
Improving missed appointments
Improving resident-nursing communication
Discharge appointment process

10. Session 2: Process Mapping

11. Session 2: Process Mapping

12. Session 3 & 4 Session 3: Identifying Wastes and Inefficiencies
Session 4: Presentations, Recommendations, Judges/Prizes

15. Challenges: For the residents
TIME, TIME AND TIME
Too many systems involved
Very complex subject
Resistance to change

16. Challenges: For Public Health students
Lack of QI knowledge among residents
Lack of awareness about systems thinking amongst residents
Lack of time to work on QI projects
Priority issues
Lack of urgency for the project

17. Challenges: For us No administrative support No funding support
Difficult to find mentors
Lack of sponsorship for the projects
Limited time line

18. Main learning points for the Residents and Students
QI projects are time intensive
There are simple, cost-effective solutions for frustrating problems
We can change the system in a systematic way and not just whining
Small steps can make a difference in overall process

19. Final presentation

20. Next Steps… Further implementation and expansion of current curriculum
Collaboration with other schools and students
More mentors
Longer duration program
Taking the show on the road

21. Questions?
Resources:

22. A Collaborative Quality Improvement Curriculum for Internal Medicine Residents and Masters of Public Health Students: The Lean Way
Gouri Gupte PhD, School of Public Health,
Charlene Weigel MD, Department of Medicine, Mount Auburn Hospital,
Winnie Suen MD, MSc, Department of Internal Medicine, Section of Geriatrics, Boston Medical Center,