An Embedded Quality Improvement Curriculum :Lessons learned from Family Medicine Residency Program Directors’ Retreat September 25, 2014
Embedded….. • b……….to make something an integral part
Goals Today • Overview of Embedded Quality Education in FM Residency • Compare Modular vs. Experiential Models • Lessons Learned • Future : The GME Value Neighborhood
Why am I excited aboutteaching improvement methodsin healthcare delivery?
“Every system is perfectly designed to obtain the outcomes it achieves.” Don Berwick, MD
What does Education in Quality Require? • Investment: Time and Energy • Teams • Creativity and Safety • Improvement Methodology Lean, Six Sigma, Model for Improvement, etc.
“ A goal without a method is cruel.” • “Best efforts will not ensure quality, and neither will gadgets, computers or investment in machinery.” W. Edward Demming HOW DO WE IMPROVE?
Quality Improvement is not NEW. Taguchi Ishikawa Deming Juran Shewhart
Improvement Methodologies • Historic: Edward Demming • Model for Improvement • Six Sigma • Lean • DMAIC • Etc.
CQI Requirements for Residents • ACGME: “Residents must be able to systematically analyze clinical practice data using quality methods and implement meaningful change.” Accreditation Council for Graduate Medical Education. Common program requirements. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramResources /Common_Program_Requirements_07012011.pdf. Accessed December 4, 2013.
Teaching Improvement2014 and beyond Modular Based Education Experiential Education
Comparing Teaching Methods Modular Experiential Adaptable Content Experiential Didactics: 9 hours of faculty led discussion Faculty and Stakeholder engagement Fixed Content No Experiential Component Didactics : 22 hours of web-based instruction No Faculty/Stakeholder engagement
Family Medicine: Improvement Curriculum • Didactics: 9 Sessions, 1 hour on the mechanics of Improvement (July- April) • Clinical Quality Meetings (CQM) July: – Dec: 1 hour sessions January – April : 30 min. sessions May & June : Team presentations
Overview : FOCUS - PDSA QUALITY MEETING: Activities Citi C U S PP D S S S Presentations Intro Topic Aim Seminar: Theory Intro Topic Aim C U S P Problem-solving, Overcoming barriers, PCMH, Leadership, etc. July Aug Sept Oct Nov Dec Jan Feb Mar April May Scholarship break
Who leads the team? • Third Year Residents with Faculty Advisor
Faculty Roles and Investment • Leadership • Didactic faculty • Team Advisors • Team members
Resident Roles • R1: Observation/Participation • R2: Team member • R3: Team Leader
What do our residents gain? Stick Carrots Knowledge of Process analysis and Improvement methods Experience Leading a team Timely Feedback: Communication and Leadership Scholarship Opportunity PCMH Skills • Required GME experience • Evaluations/Milestones • NEW: Board Certification (Step4)
What do learners in Modular Systems Acquire • Knowledge of Process analysis and QI methods • Experience Leading a team • Timely Feedback on communication and leadership • Scholarship Opportunity • PCMH Skills
What about project Failures • Learning • Skillsets • Continuous Learning: repeat cycles
Scholarship Prior to Experiential Quality Curriculum (2006-2010) After Experiential Quality Curriculum (2010-2014) 12 National Presentations 2 Regional Presentations 1 National Award (Pfizer QI award) Highest Ratings for Patient Centered Medical Home Metrics in Quality • 1 Resident National Presentation • No Regional Resident Presentations • No awards • Lowest Ratings Patient Centered Medical Home Metrics in Quality
Lessons Learned • Faculty engagement is key to success • Teams • Time for team meetings • Stakeholders support • Umbrella IRB • Citi Training for all residents • Scholarship Calendar • Build relationships
Future Goals • GME Alignment • Value Alignment Value = (Quality x Service) / Cost • Operational Goals Resident CQI Aims • Triple Aim (clinical operations, education translational scholarship)
Value improvement methodology at UUHC • 6s Lean PDSA Project Definition Baseline Analysis Investigation Improvement Design Improvement Implementation Monitoring
Questions? • Oath