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The American Board of Pediatrics: Efforts in Patient Safety and Maintenance of Certification Wednesday, December 5, 2007 12:00 – 1:00 p.m. EST. Moderator: Marlene R. Miller, MD, MSc, FAAP Vice President, Quality National Association of Children’s Hospitals and Related Institutions (NACHRI)

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The American Board of Pediatrics:Efforts in Patient Safety and Maintenance of CertificationWednesday, December 5, 200712:00 – 1:00 p.m. EST


Moderator:

Marlene R. Miller, MD, MSc, FAAP

Vice President, Quality

National Association of Children’s Hospitals and Related Institutions (NACHRI)

Alexandria, Virginia


This activity was funded through an educational grant from the Physicians’ Foundation for Health Systems Excellence.


D the Physicians’ Foundation for Health Systems Excellence.isclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities Grid

The AAP CME program aims to develop, maintain, and increase the competency, skills, and professional performance of pediatric healthcare professionals by providing high quality, relevant, accessible and cost-effective educational experiences. The AAP CME program provides activities to meet the participants’ identified education needs and to support their lifelong learning towards a goal of improving care for children and families (AAP CME Program Mission Statement, August 2004).

The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest.

All AAP CME activities will strictly adhere to the 2004 Updated Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity.

The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.


Disclosures
DISCLOSURES the Physicians’ Foundation for Health Systems Excellence.


Disclosures1
DISCLOSURES the Physicians’ Foundation for Health Systems Excellence.


Disclosures2
DISCLOSURES the Physicians’ Foundation for Health Systems Excellence.


Cme credit
CME CREDIT the Physicians’ Foundation for Health Systems Excellence.

The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The AAP designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity is acceptable for up to 1.0 AAP credit. This credit can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Fellows of the American Academy of Pediatrics.


Other credit
OTHER CREDIT the Physicians’ Foundation for Health Systems Excellence.

This webinar is approved by the National Association of Pediatric Nurse Practitioners (NAPNAP) for 1.2 NAPNAP contact hours of which 0.0 contain pharmacology (Rx) content. The AAP is designated as Agency #17. Upon completion of the program, each participant desiring NAPNAP contact hours should send a completed certificate of attendance, along with the required recording fee ($10 for NAPNAP members, $15 for nonmembers), to the NAPNAP National Office at 20 Brace Road, Suite 200, Cherry Hill, NJ 08034-2633.

The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)TM from organizations accredited by the ACCME.


Paul V. Miles, MD, FAAP the Physicians’ Foundation for Health Systems Excellence.

Vice President

Director of Quality and Practice Assessment

The American Board of Pediatrics

Chapel Hill, North Carolina


Learning objectives
Learning Objectives the Physicians’ Foundation for Health Systems Excellence.

Upon completion of this activity, you will be able to:

  • Discuss the role of the American Board of Pediatrics (ABP) in improving children’s health care quality and safety.

  • Apply the new Maintenance of Certification process to your own individual situation.

  • Describe the role of the ABP in specific projects to improve knowledge and delivery of safe care to children.


Patient safety as a professional competency

Patient Safety as a Professional Competency the Physicians’ Foundation for Health Systems Excellence.

The American Board of Pediatrics: Efforts in Patient Safety and Maintenance of Certification

Safer Health Care for Kids Webinar

Dec 5, 2007

Paul V. Miles MDVice President for Quality and Practice Assessment

American Board of Pediatrics


To Err is Human the Physicians’ Foundation for Health Systems Excellence.:

The IOM recommended that standards

for provider competence and knowledge

of patient safety be developed and

that assessment and reassessment on a

periodic basis be done.

P Miles ABP


“The ability to assess and systematically the Physicians’ Foundation for Health Systems Excellence.

improve the safety of medical practice is

an essential competency of every certified

physician.”

…..ABMS-CMSS Joint Planning Committee, December 2002

P Miles ABP


Six Core Physician Competencies the Physicians’ Foundation for Health Systems Excellence.

Applied to Patient Safety

  • Patient care

  • Medical knowledge

  • Interpersonal and communication skills

  • Professionalism

  • Practice-based learning and improvement

  • Systems-based practice

(Adopted by the ACGME and all twenty four ABMS specialty boards)

P Miles ABP


Person approach vs system approach
Person Approach vs. System Approach the Physicians’ Foundation for Health Systems Excellence.

“Naturally enough, the associated countermeasures are directedmainly at reducing unwanted variability in human behavior. Thesemethods include poster campaigns that appeal to people's senseof fear, writing another procedure (or adding to existing ones),disciplinary measures, threat of litigation, retraining, naming,blaming, and shaming. Followers of this approach tend to treaterrors as moral issues, assuming that bad things happen to badpeople what psychologists have called thejust world hypothesis.1”

P Miles ABP

Reason, J BMJ 2000;320:768-770 ( 18 March )


Person approach vs system approach1
Person Approach vs. System Approach the Physicians’ Foundation for Health Systems Excellence.

“The basic premise in the system approach is that humans are fallible and errors are to be expected, even in the best organizations.Errors are seen as consequences rather than causes, having theirorigins not so much in the perversity of human nature as in "upstream"systemic factors.”

P Miles ABP

Reason, J BMJ 2000;320:768-770 ( 18 March )


Dreyfus model for learning
Dreyfus Model for Learning the Physicians’ Foundation for Health Systems Excellence.

  • Novice

  • Advanced beginner

  • Competent

  • Proficient

  • Expert

P Miles ABP


Medical career continuum
Medical Career Continuum the Physicians’ Foundation for Health Systems Excellence.

  • Novice………………………Medical student

  • Advanced beginner…….Beginning resident

  • Competent………..…………Senior resident

  • Proficient………….…7-10 years into career

  • Expert……...…....Senior faculty/practitioner

P Miles ABP


Improvement Focus the Physicians’ Foundation for Health Systems Excellence.

Educational System Improvement

Number of Pediatricians

Residents Faculty

Standard

Novice – Competent - Expert

P Miles ABP


Team and system competency
Team and System Competency the Physicians’ Foundation for Health Systems Excellence.

  • The same progression from novice to expert applies to teams and microsystems

  • The ABP will accept team data for certification of individuals

P Miles ABP


Personal Competency and Quality Care the Physicians’ Foundation for Health Systems Excellence.

J. Bingham & D. Quinn Vanderbilt

P Miles ABP


Personal competency and patient safety
Personal Competency and Patient Safety the Physicians’ Foundation for Health Systems Excellence.

P Miles ABP


Competency in teamwork
Competency in Teamwork the Physicians’ Foundation for Health Systems Excellence.

  • Team Knowledge:

    • Knowledge about components of teamwork

    • Shared models

    • Knowledge of teammate characteristics

    • Knowledge of team mission, norms, objectives, and resources

    • Task-specific responsibilities

Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005

P Miles ABP


Competency in teamwork1
Competency in Teamwork the Physicians’ Foundation for Health Systems Excellence.

  • Skills:

    • Closed-loop communication

    • Team leadership

    • Mutual performance monitoring

    • Backup behavior

    • Adaptability

  • Attitudes:

    • Belief in the importance of teamwork

    • Mutual trust

    • Team orientation

Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005

P Miles ABP


Measurement of team performance
Measurement of Team Performance the Physicians’ Foundation for Health Systems Excellence.

  • Must be grounded in team theory

  • Must account for individual and team-level performance

  • Must capture team process and outcomes

  • Must adhere to accepted standards for reliability and validity

  • Must address and real or perceived barriers to measurement

Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005

P Miles ABP


Abp maintenance of certification version 1 1 requirements
ABP Maintenance of Certification Version 1.1: Requirements the Physicians’ Foundation for Health Systems Excellence.

Part 1: License

Part 2: Knowledge & Decision Skills SA

Part 3: Secure examination

Part 4: Component A – Patient Survey

Component B – Approved activity

P Miles ABP


Version 1 1 how much time
Version 1.1: How much time? the Physicians’ Foundation for Health Systems Excellence.

7-year certificate

NOTE: Approximate times are actual “seat” time and do not include preparation time

P Miles ABP


What is part 4
What is Part 4? the Physicians’ Foundation for Health Systems Excellence.

  • Component A

  • Patient Survey

  • Component B

  • Option 1: Approved web-based module

    • AAP eQIPP modules

    • Patient Safety module

    • PIM module + self-assessment combination package

      • eg. Asthma PIM + QI Self-assessment

  • Option 2: Approved collaborative

    • eg. VON project + QI Self-assessment

+

Note: Activities listed under the Component B options are for example purposes only; other activities exist.

P Miles ABP


A Proposal to Design, Develop, and Deploy a the Physicians’ Foundation for Health Systems Excellence.Web-based Patient Safety Education and Improvement Module That Will Meet the Requirements for Part 4 Maintenance of Certification TM


A collaborative effort
A Collaborative Effort the Physicians’ Foundation for Health Systems Excellence.

  • ABMS – lead organization

  • ABP/AAP

  • ABFP/AAFP

  • ABIM/ACP

  • Surgery, anesthesiology, other specialties

  • VA, DoD, AHRQ,

  • National experts on patient safety

P Miles ABP


Features
Features the Physicians’ Foundation for Health Systems Excellence.

  • Designed to work for all 650,000+ board certified physicians across 24 specialties

  • Designed to work for non practicing physicians

  • Before and after knowledge self assessment

  • Quality improvement approach

  • Designed to work with local improvement efforts

  • Hot Links to key Patient Safety Web sites

P Miles ABP


www.abms.org the Physicians’ Foundation for Health Systems Excellence.

P Miles ABP


www.abms.org the Physicians’ Foundation for Health Systems Excellence.

P Miles ABP


ABMS Patient Safety Improvement Program the Physicians’ Foundation for Health Systems Excellence.

www.abms.org

P Miles ABP


Other abp safety initiatives
Other ABP Safety Initiatives the Physicians’ Foundation for Health Systems Excellence.

  • Patient safety content in certifying exams and other parts of the certifying process

  • ABP approval of patient safety improvement projects to meet the requirements for MOC Part 4

  • Alliance for Pediatric Quality has selected patient safety as one of the three initial Improve First initiatives

P Miles ABP


Eliminating bloodstream infections
Eliminating Bloodstream Infections the Physicians’ Foundation for Health Systems Excellence.

NACHRI CA-BSI Collaborative

In the first 6 months,

29 children’s hospitals

reduced infection ratesin the PICU by nearly

70 percent by adhering to a rigid set of evidence-based practices shown to prevent infections in children.

70% improvement: estimated 20 lives saved, 160 infections prevented,

$6.4 million not spent in the first 6 months

P Miles ABP


Resources for patient safety
Resources for Patient Safety the Physicians’ Foundation for Health Systems Excellence.

  • AHRQ Web M&M site www.ahrq.gov

  • To Error is Human IOM

  • Creating systems of safe care IOM

  • To Do No Harm – Julie Morath

  • ABMS Web-based patient safety module

P Miles ABP


Now what some take away points from the webinar

Now What?!? the Physicians’ Foundation for Health Systems Excellence.Some take-away points from the Webinar:

  • The ABMS Patient Safety Program is valuable for all physicians

  • Participate in a local, regional or national safety improvement project

  • Engage in the AAP Safer Health Care for Kids effort

  • Create a culture of safety in your practice

  • Maintain board certification


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