Teaching & Mentoring Residents & Fellows in Quality Improvement

GME SymposiumOctober 3, 2014

Curriculum Development & Planning SlidesJennifer Myers MD

What is the ACGME Looking for?“Top” of the Pyramid

Miller’s Pyramid for Learner Assessment

“Milestone” ReportingA Sample from a QI Milestone Reporting Worksheet

Applies performance improvement methodologies

Participates in process improvement to optimize ED practice

#20. PBLI: Participates in performance improvement to optimize ED function & pt care

Yeah…But What About My Specialty?

General Surgery • The resident performs basic steps in a QI project

Internal Medicine & Medicine Subspecialties• Actively engages in quality improvement initaitives• Demonstrates the ability to apply common principles & techniques of

QI to improve patient care for a panel of patients

Radiation Oncology• Able to define and construct process & outcomes measures of quality• Designs & completes a QI project

Common Questions • Do trainees need to be “doing” QI every year of

their training?– NO

• Does each trainee need to lead their own separate project?– NO

• How much active participation does each trainee need to have in the QI project?– We don’t know. The ACGME has not defined this…

Curriculum Development Process

Kern’s 6-Steps Problem Identification &

General Needs Assessment Needs Assessment of Targeted Learners Goals & ObjectivesEducational StrategiesImplementationEvaluation & Feedback

Step By Step Approach

Educational StrategiesImplementation

Step 3:Project

Management

Step 2:Project

Selection

Step 1:Make a Plan

Step By Step Approach

Educational StrategiesImplementation

Step 1:Make a Plan

Step 2:

Step 3:

Step 1: Make a Plan(aka: Educational Strategies)

• Who will teach the content?– Teacher Options:

• You!• You + one of us to co-teach & facilitate

• How?– Format Options

• Teach content all at once • Flipped Classroom• Teach content piecemeal for just-in-time learning & use• Think about involving non-housestaff in the activity (faculty, nurses, other

staff)

• When?

Step 1: Make a Plan(aka: Educational Strategies)

• What level of learner will you involve?

• Who will guide them longitudinally through the project?

• Who is not here that you can potentially enlist to help?

Step 1: Make a PlanProject Organization Options

Option 1: Several Trainees (2 -10) = One “Program” Project

Option 2: Many Trainees (>10) = One project “handed off” or more 2 or more program projects

Option 3: One Trainee = One Project

OK – Make a Plan!

10 minute Activity

Take a few minutes to fill out the top of the worksheet grid.

If you are here with others in your program, you should work on it together

Step By Step Approach

Educational StrategiesImplementation

Step 1:Start to Plan

Step 2:Project Selection

Step 3:

Step 2:Project Selection

• Perhaps the most important decision you will help your trainees to make

• Think small and doable, not big and complex – SCOPE

Think about the “A” (ACHIEVABLE) in SMART goal

• Look for projects that align with division, departmental, hospital, or clinic quality goals– Think about the “R” (RELEVANT) in SMART goal

• A project that is just starting in your division/dept that the trainees can join

• Something that interests the residents or fellows

Step 2: Project Selection

“ Top-Down” vs “Bottom-Up” Approach to Project Selection

Step 2: Project Selection

• Who needs to approve? – Division/Department leadership– We in CEQI are working on a process for this

• Who needs to be informed?– Stakeholder Analysis: develop a communication plan

Step By Step Approach

Educational StrategiesImplementation

Step 1:Start to Plan

Step 2:Project Selection

Step 3:Project

Management

Step 3: Project Management

Assume trainees know nothing (and I mean nothing)

about managing a project and running meetings

You Will Need to Make Connections for the Residents & Fellows

One success factor for trainee QI projects is faculty mentors who have local system knowledge and

deep connections within the organization*

Ogrinc G, et al. Academic Medicine, 2014

What are we connecting the trainees to?

Residents & FellowsInfrastructure

Data

People in our Organization

Is there 1 or more residents or fellows who have an interest in this area?

• Consider having them lead or co-lead the project• Opportunities for them to get additional training

– Healthcare Leadership in Quality Track• Director: Neha Patel (table #6)

– CHIPS Fellowship• Director: Jen Myers (table #1)

– Performance Improvement Training (PIIA)• Chris Klock (table #7)

– Masters course in QI methods (fall semester)• Kathy Burke & Jen Myers

– Have them attend our workshops/office hours with you

Proposed Timeline for Penn GME QI Curriculum

Today Oct Nov Dec Jan Feb Mar Apr May->

Planning X

Select a QI project area X

Problem Statement X

Current Condition (baseline data, observation, process maps)

X

Root Causes(5 whys, pareto, fishbone)

X

Target Condition & Measures (SMART aim)

X

First Test of Change (PDSA cycle)

X

2nd, 3rd Test of Change;Eventually make it “Standard Work”

X

= STOP! DID YOU DO THE “APPROVE” & “INFORM” STEPS?

Resources

• People – All of us– CEQI Staff in your division/dept/unit

• Tools – Everything from today & more is up on the GME website

• More Training Opportunities– QI “Office Hours”….more to come!– Performance Improvement in Action Curriculum– Graduate School Course in QI (fall semester)– Reading List (annotated bibliography in folders)

GME Quality & Safety On-Line Toolkit

Everything we have shown you and talked about today is here

Data

Data Resources for Quality(readily available online)

Inpatient Quality Datamart

- Healthcare Associated Infections

- Patient Experience Scores (HCAHPS)

- Patient Safety Indicators- Readmissions- CMS Core Measures- Mortality

Ambulatory Analytics- Patient Access

- Call Volume- New Patients Seen w/i 2 wks- Visit Data

- Patient Experience- Preventative Care

- Cancer screeneing- Tobacco screening/counseling- Vaccinations

- Diabetes Care Indicators

Other Data Resources

- Patient Experience – Mike Anderson- Administrative Data – Jeff Rohrbach- Cost Data – Chad Johnston- Patient Safety

- Penn Medicine Safety Net – Luther Kay- Safety Culture Survey Data – Venkat Panchmanadam

- Discrete SCM/EPIC data - Penn Data Store request form- GME & CEQI working together on this