The High Value Idea Competition: Engaging housestaff and institutional leaders in high value care

From the 2019 HVPAA National Conference

Dr. Emily Mallin (University of Arizona College of Medicine – Phoenix), Dr. Kinal Bhatt (University of Arizona College of Medicine – Phoenix), Dr. Cheryl O’Malley (University of Arizona College of Medicine – Phoenix)

Background

Education in patient safety and quality improvement is an ACGME requirement, yet we continue to strive to find the best strategies to teach high value care. Our institution created the GME High Value Idea (HVI) competition in order to provide real-world education in quality improvement and high value care. The competition was chosen as a national “bright idea” winner in the “Teaching Value and Choosing Wisely Contest” sponsored by the ABIM and Costs of Care in 2013.

Objective

The GME high value idea competition seeks to increase housestaff ability to effectively design, implement, and study their high value idea in our clinical learning environment and to facilitate alignment of institutional goals and engagement by institutional leadership.

Methods

Each year, housestaff are invited to submit abstracts on a high value idea in any stage of development. Criteria for selection in that they included alignment with institutional strategic priorities, national recommendations around choosing wisely. The winning projects receive a cash prize, mentorship and a multi-disciplinary team to support implementation. Results are presented at the annual Housestaff Quality and Safety Day (QSD), along with posters highlighting other quality projects. Oral presentations are judged by invited leaders within the academic institution and health system, based on quality of the work and presentation, scalability, cost savings, and sustainability. Support for the program is provided by the medical staff of the institution and by the Office of Graduate Medical Education.

We completed an IRB-approved qualitative study of the impact of the HVI Competition on housestaff winners.

Results

Residents and fellows representing twenty winning projects over 5 years were contacted to participate in interviews, of which 12 (60%) participated. 11 out of 12 participants (92%) reported having received QI education during residency program. 67% participants had been involved in other quality improvement projects in addition to HVI competition. 83% of winning projects were implemented at the institution. Of those, more than half of the interventions were sustained over time. 75% of participants have disseminated their winning idea beyond the competition (e.g. publications, local or national poster and oral presentations). 83% of participants noted no impact of the competition on post-graduate plans, however, 100% felt they had benefited from participation in the competition.

Conclusions

Our GME High Value Idea competition is an effective, engaging educational intervention with broad impact in various areas of our institution and beyond. Housestaff value the opportunity and support of the program in order to more successfully design, implement, and study the impact of interventions they personally develop. Unit and institutional leaders remain supportive partners in the program.

Clinical Implications

Several of the interventions have led to institution-wide and in some cases, health system-wide changes, demonstrating the impact of high value care far beyond the individuals who participate in the program. Equally important is the impact housestaff perceive they are making when engaged in QI work, inspiring ongoing engagement in QI in their future practice. Finally, the competition has served to advance all trainees’ awareness of and opportunities in delivering high value care.

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