Swimming with the Sharks: Using a novel Quality Improvement Curriculum to Align Housestaff and Institutional Goals

From the 2019 HVPAA National Conference

Dr. Kevin Hauck (NYU), Dr. Scott Statman (NYU Langone Health), Dr. Andrew Dikman (NYU Langone Health), Dr. Brian Bosworth (NYU Langone Health), Dr. Matthew Durstenfeld (NYU Langone Health), Dr. Kerrilynn Carney (Yale School of Medicine)

Background

Quality Improvement (QI) training in graduate medical education (GME) is rarely aligned with institutional administration. While QI rotations are a natural environment to discuss health care value and cost-effectiveness, the transient and often passive format of existing curricula prohibits housestaff from truly integrating into departmental and hospital-wide quality improvement activities.

Objective

To create a hands-on curriculum to teach GME trainees about quality improvement that culminates in an interactive session for residents to pitch ideas to hospital leadership, and then support housestaff in development and implementation of these projects.

Methods

We implemented a two-week QI rotation in two parts. In the first, trainees received instruction in Lean management principles, the implementation of QI projects, institutional patient safety tools, and high-reliability organization principles.

In the second portion of the curriculum, participants used this training to design a value-based quality improvement project. Residents were divided into small groups, paired with faculty advisors, and tasked with identifying practices that are inefficient, unsafe, or low-value. Housestaff worked directly with hospital value-based management (VBM) project managers and decision support analysts to perform rapid needs assessments, and drew on local and national data to analyze opportunities for improvement and design potential solutions.

Participants presented their projects at a formal “Shark Tank” event. Here, senior clinical and administrative leadership, including the Chief Medical Officer, Chief Quality and Safety Officer, Chief of Medicine, and Clinical Lead of VBM, scored projects on projected value, impact, feasibility, creativity, and alignment with departmental and institutional goals. Participants received focused feedback on their ideas, methodology, and presentations. Projects scoring well received institutional support and mentorship to implement their projects.

Results 

In its first two years, 92 residents participated in the curriculum in 19 teams, resulting in 19 project pitches. Overall, 94% recommended the course. Participants reported an increase in their ability to identify unsafe or inefficient processes in the hospital, and use principles of Lean management to propose solutions. Participants also reported significant increases in their likelihood to participate in quality, safety, and value projects, knowledge on how to find faculty mentors, and comfort suggesting quality, safety, and value proposals to medicine leadership.

Four of the nine pitches from the first iteration in 2017 received institutional support, resulting in hospital improvements under the guidance of faculty mentors. These projects aimed to decrease computed tomography use in suspected pancreatitis, implement a rapid testing protocol for suspected tuberculosis, create a bedside procedure service, and decrease the time between glucose testing and insulin administration.

Conclusions

In the first two years of implementation of our QI curriculum, trainees reported improvement in all learning objectives. Moreover, this program led to the implementation of at least four resident-led QI projects with full institutional support.

Clinical Implications

Our novel project-based curriculum in quality improvement culminating in a pitch to hospital leadership successfully engaged GME trainees and generated successfully implement QI projects, suggesting avenues of collaboration between hospital administration and GME trainees.

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