Beyond PDSA Cycles: Ambulatory QI Training

Transcription

1 Beyond PDSA Cycles: Ambulatory QI Training Alexander M. Djuricich, MD Program Director, Medicine-Pediatrics Residency Associate Dean for CME Indiana University School of Medicine APDIM Plenary III October, 2013 Nothing to disclose Disclosure

2 What We ll Cover Addressing Barriers QI Education Journey How might one create successful resident QI curriculum? Barriers to integrating residents into QI & PS Time Faculty Expertise Institutional Buy-In Assessment

3 Biggest Barrier - Culture [MY CLINIC] is where resident QI projects go Biggest Barrier - Culture [MY CLINIC] is where resident QI projects go to DIE

4 Our Program 115 Categorical Residents 50 Medicine/Pediatrics 4 Teaching Hospitals 15 Ambulatory Clinic Sites IN Univ Medicine Prog Structure University County VA Community

5 Background Teaching basic quality improvement methodology: no longer innovative in 2013 QI Education RRC requirements VI.A.3 residents are integrated & actively participate in interdisciplinary clinical QI and PS programs. Voss JD, et al. Changing conversations: teaching safety and quality in residency training. Acad Med 2008;83: Singh R.et al. A comprehensive collaborative patient safety residency curriculum to address the ACGME core competencies. Med Educ 2005;39: Vinci LM, et al. Effect of a quality improvement curriculum on resident knowledge and skills in improvement. Qual Saf Health Care 2010;19(4): RRC-IM Requirements. Found at PIF/140_internal_medicine_ pdf

6 How to Integrate QI? Where to put the curriculum? Learn System QI 101 QI 201 How to Integrate QI? Where to put the curriculum? Learn System QI 101 QI 201

7 QI Topics Basic Lean-Six Sigma methodology during PGY3 immersion week Value stream and Process Mapping Project charter Rapid Process Improvement Event PGY3 Immersion Week Voice of the Customer: Interview a sample of the customers of the process. Measurement and Observations Tools: Create and complete measurement or observations tools for each process. Create a project charter with appropriate scope. Complete a current state process map and share with your clinic staff so that they may interact with and possible have input to the map Complete a future state process map and share with your clinic staff so that they may interact with and possible have input to the map Design small tests of change and assess these changes. Complete the final project poster via PowerPoint and forward to our office

8 Understanding and Improving Systems Assessing Waste and Value Understanding Flow Process Mapping Your Current State Process Map Future State Process Mapping LEAN Tools for Improving Systems Designing Small Test of Change

9 Assessment Part 1 Morrison L, et al. The QIKAT: an instrument to assess knowledge application in PBLI. J Gen Intern Med 2003:18:250. Assessment Part 2 Modifed version of 2007 Leenstra et al QI proposal assessment tool

10 Assessment Part 3 Reflections talking/working with clinic staff/personnel to implement a project learning how to break down and analyze a potential area for process change seeing other clinics problems learning activities encouraged innovative ideas to solve problems IN Univ Medicine Prog Structure University County VA Community

11 Indiana Univ Medicine Chiefs University County Ambulatory VA Community Indiana Univ Medicine Chiefs University County Ambulatory VA QIPSCR Community

12 Chief Medicine Residency Chief resident might combine medical skills with a study of education in order to further ability as a teacher of medicine and also to produce scholarly work in this area. Innovations with this year can be adapted for each hospital, with consideration of its special needs and opportunities. Steel K. The medical chief residency in university hospitals. Ann Intern Med 1972; 76(4): Chief Medicine Residency Chief resident might combine medical skills with a study of education in order to further ability as a teacher of medicine and also to produce scholarly work in this area. Innovations with this year can be adapted for each hospital, with consideration of its special needs and opportunities. Steel K. The medical chief residency in university hospitals. Ann Intern Med 1972; 76(4):

13 Chief Resident Internal Medicine Role of chief resident has evolved Educator Administrator Patient care provider Middle Manager Berg DN, et al. Middle manager role of the chief medical resident: an organizational psychologist s perspective. J Gen Intern Med 2007;22(12): QI & PS Chief Resident Receives formal training through VA Quality Scholars Program The TRUE driver of the QI 201 curriculum during PGY3 immersion week Still understand resident point of view

14 Example Faculty Resources in QI VA Quality Scholars Fellowship Program SGIM Quality Improvement Skills for Reliable Care April 2014 AAIM-SHM Quality & Safety Educators Academy May 2014 Lessons Learned QI Chief is indepensable Have MORE THAN ONE faculty QI champion resources ARE out there! Immersion Week for formal activities Set explicit expectations up front Buy-In from clinic managers (who themselves are likely going through QI training) Do QI on EDUCATION PROGRAM as well

15 Contact Info