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Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of...
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Foundational Resident Training in Quality: Alignment Leads to Results
Susan Pohl, MDDirector of Quality Improvement Curriculum
Sonja Van Hala, MD, MPH, FAAFPResidency Program Director
University of Utah
Program Director’s Retreat
September 24, 2015
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QI Requirements for Residents in Every Specialty
Residents are expected to:“systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement”
Accreditation Council for Graduate Medical Education. Common program requirements. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed March 11, 2015.
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Goal: Exceptional Value
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Objectives
Background of the quality curriculum in Family Medicine Residency Program
Methods used to create a culture of quality
Outcomes of a quality culture Future opportunities
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Background
• Clinic quality metrics plateaued• QI projects showed limited long-term
impact • Scholarship was not linked to work on
quality
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Curriculum Overview
• Longitudinal curriculum across academic year
• Structured time for resident-led quality improvement teams
• Leadership coaching of senior residents by faculty
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Madsen Health Center
Sugarhouse Health Center
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ClinicQualityMeeting
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Culture of Quality:Clinic Quality Meeting (CQM)
7:30 AM – 8:15 AM Quality Overview Vision and Strategy
8:20 AM – 9:05 AM Clinic Business MeetingOrganizational GoalsSafety/Environment of Care
9:10 AM – 9:40 AM Clinical Team MeetingFocus on Population Health, Review Data, Action Plan
9:45 AM – 10:40 AM CQI Team MeetingsResident-led & faculty mentored; All faculty, residents, and staff participate on a team
10:45 AM – 11:30 AM Ad Hoc Groups Address Clinical and Educational issues
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Third Year Resident as Team Leader
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“Just in Time Teaching”QI Curriculum
July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June
FOCUS-PDSA Methods, Leadership Skills
CLINIC QUALITY MEETING
SEMINAR
Presentations FOCUS-PDSA Application
Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.
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Childhood Vaccination• Madsen Family Health Center (2011): 66%• Aim: Improve vaccination rate to 90% for
children under age 2• Intervention:
• Daily printed vaccine report for each child scheduled in clinic
• Distribute report to providers in huddle• Improved to 92% over the five month
intervention• Three years later, improvement was sustained
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Culture of Quality:The Role of Faculty
Expectation of faculty engagement• Quality Champions
– Chief Value Officer– Curriculum Director
• Seminar instructors• Team advisor• Team member
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Culture of Quality:Resident Roles
• R1: Observation/Participation• R2: Team member• R3: Team leader
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Resident–LedQI Teams
Community Clinics
Operational Goals 2015
HEDIS Measure
Clinical and Research
Priority
Diabetes Mellitus control Hba1c < 9.0 X X
HTN control X X
Chlamydia Screening X X
Childhood Immunization X
Adult Immunization X X
QI Projects for 2015-2016
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Family Medicine 2013 Apr;45(4):235-9.
Outcome – OptimizingResearch
Educational Actualization
Clinical Transformation
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Childhood Vaccination• Madsen Family Health Center (2011): 66%• Aim: Improve vaccination rate to 90% for
children under age 2• Intervention:
• Daily printed vaccine report for each child scheduled in clinic
• Distribute report to providers in huddle• Improved to 92% over the five month
intervention• Three years later, improvement was sustained
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2015 QI Scholarship• Hypertension Control• Enrollment in Chronic Pain Pathway• Pneumococcal Vaccination in Adults• Physical Activity Counseling in Children• Chlamydia Screening• Hemoglobin A1c• Childhood Immunizations• Asthma
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2015 QI Scholarship• Hypertension Control• Enrollment in Chronic Pain Pathway• Pneumococcal Vaccination in Adults• Physical Activity Counseling in Children• Chlamydia Screening• Hemoglobin A1c• Childhood Immunizations• Asthma
Annual Spring ConferenceApril 2015
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2015 QI Scholarship• Hypertension Control• Enrollment in Chronic Pain Pathway• Pneumococcal Vaccination in Adults• Physical Activity Counseling in Children• Chlamydia Screening• Hemoglobin A1c• Childhood Immunizations• Asthma
Evidence Based Practice FairMay 2015
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2015 QI Scholarship• Hypertension Control• Enrollment in Chronic Pain Pathway• Pneumococcal Vaccination in Adults• Physical Activity Counseling in Children• Chlamydia Screening• Hemoglobin A1c• Childhood Immunizations• Asthma
70th Annual ConferenceMay 2015
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2015 QI Scholarship• Hypertension Control• Enrollment in Chronic Pain Pathway• Pneumococcal Vaccination in Adults• Physical Activity Counseling in Children• Chlamydia Screening• Hemoglobin A1c• Childhood Immunizations• Asthma
CCC (Community Clinics Council) Quality CommitteeJune 2015
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2015 QI Outcomes• Chlamydia Screening
– 5% increase with patient education, provider prompts
• Hemoglobin A1c– Proactive scheduling of appointments improved A1c
• Enrollment in Chronic Pain Pathway– Identification system improved enrollment 18%
✔
✔
✔
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2012 STFM Family Practice Management Award for Practice Improvement
2014 HealthInsight Quality Award
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Adding Value
I gained confidence in the role of leading a group, while learning more how to integrate the thoughts and ideas of others. –Third year FM resident
My skills for leading and directing a team meeting, delegating responsibility, keeping team members accountable and most importantly engaging all team members for contributions has dramatically improved.–Third year FM resident
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Dissemination• University Utah Evidence-Based
Practice Fair 2014, 2015• Ogden Surgical-Medical Society
2015• Society of Teachers of Family
Medicine: 2011, 2012, 2013, 2014, 2015
• National FM Program Directors Workshop: 2012, 2013
• Ghana International Medical Seminar. Kintampo, Ghana: 2013
• Clinical Quality Improvement of Family Medicine in an Aging World; Tsukuba Global Science Week. Tsukuba, Japan: 2014.
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Keys to Success:Creating a Culture of Improvement
• Faculty champion• Expectation of faculty engagement• Alignment with operational goals• Multidisciplinary teams • Committed time for team meetings• Broad leadership support
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Future Directions
• Value Summaries • Part IV Credit• Program Director’s Needs Assessment
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Value Summaries & Part IV Credit
Insert picture of a value summary
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Program Needs Assessment
• Please complete 5 minute PD survey• Inform the development of a foundational
QI curriculum, exportable to GME programs
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Leveraging QI to 3 Missions
Skate to where the puck is going to be, not to where it has been.
Wayne Gretzky