Overview:
The quality improvement curriculum is intended to be a longitudinal experience comprised of lectures, online modules, committee meetings and office based experiences in which residents will work in multidisciplinary teams to complete quality improvement projects.
Goals:
- Define the expectations and requirements for quality improvement education.
- Provide a structured educational experience in core concepts of quality improvement.
- Provide a structured system to ensure that residents are able to design, implement and measure quality improvement projects in a multidisciplinary fashion.
- Complete one Maintenance of Certification Level 4 Performance Improvement Project per the American Board of Family Medicine requirements.
Objectives:
At the completion of the three-year curriculum residents will:
- Partner with patient, family and community to improve health through disease prevention and health promotion (PC-3)
- Provide cost-conscious medical care (SBP-1)
- Emphasize patient safety (SBP-2)
- Advocate for individual and community health (SBP-3)
- Improve systems in which the physician provides care (PBLI-3)
Implementation:
Educational Methods
Quality Improvement is intended to be a three-year longitudinal experience. While it is anticipated that comfort and leadership with quality improvement projects will occur in the second and third years of residency, this curriculum aims to educate residents during all three years of their training.
The curriculum will consist of scheduled lectures on quality improvement to be integrated into the existing monthly continuous quality improvement (CQI) lecture series. Additional involvement and engagement in committee meetings to identify areas for improvement is expected. To supplement key concepts, residents will complete online modules from the Institute for Healthcare Improvement (IHI) during specified rotations (Appendix A).
Quality improvement projects will be integrated into pre-existing subdivisions of clinic infrastructure. Residents, nurses, medical assistants, behavioral medicine team members and front desk staff will work in a multidisciplinary fashion to identify areas for improvement in the quarterly “Color Team Meeting” noon conference sessions (Appendix B). Residents and faculty will lead the team to design a project and will carry out bi-annual PDSA cycles. PGY1 residents will be involved in projects, but it is expected that leadership on the Quality Improvement team will increase throughout their training with PGY3 residents and faculty ultimately leading the team. Key concepts and project updates will be reinforced in monthly CQI lectures. The Clinic Committee will be responsible for monitoring and tracking quality improvement projects in addition to serving as a clearing house for possible future projects (Appendix C).
Resident Responsibilities
Residents are expected to meaningfully participate in the development of quality improvement projects. It is expected that PGY1 residents will participate in clinic quality improvement projects and will grow to take more of a leadership role on the team with the ultimate goal of leading and orchestrating quality improvement projects their third year. Quality improvement projects will engage and incorporate multiple members of the health care team and will involve leadership and support from faculty.
Residents are expected to complete assigned modules during their assigned rotations (see Appendix A).
Residents are expected to log their quality improvement project on ABFM prior to registering for their board exam. It is expected that residents will have been involved in multiple quality improvement projects prior to this timeframe.
Residents are encouraged to submit projects for presentation and publication. Faculty will remain available for mentorship to aid in this process.
Resources
Institute for Healthcare Improvement. Open School.
http://www.ihi.org/education/IHIOpenSchool/courses/Pages/default.aspx
To access IHI courses go to:
http://www.ihi.org/Pages/default.aspx
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- Education
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- Online Courses
- Courses Overview
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- Improvement Capability
Methods of Evaluation
Residents will receive multiple evaluations throughout their quality improvement education. Immediate feedback of quality improvement projects will occur upon completion of the project by the faculty lead on the team. Additionally, milestones tied to quality improvement will be embedded within rotational evaluations. Quality improvement projects and resident development through each successive PGY year will be discussed with residents during their periodic evaluations with their team leader. Annually, one quality improvement project will be selected by the faculty to be highlighted as the most influential and best designed project.
Appendix A
During the below specified rotation in each PGY year, the resident will be expected to complete the designated modules on IHI Open Course.
- PGY1: PMPH
- Q1 101: Introduction to Healthcare Improvement
- Q1 102: How to Improve with the Model of Improvement
- Q1 102: Testing and Measuring Changes with PDSA Cycles
- PGY2: Ambulatory Subspecialty Pediatrics
- Q1 104: Interpreting Data: Run Charts, Control Charts, and Other Measurement Tools
- Q1 105: Leading Quality Improvement
- PGY3: Geriatrics
- Q1 201: Planning for Spread: From Local Improvements to System-Wide Change
- Q1 202: Addressing Small Problems to Build Safer, More Reliable Systems
Appendix B
Quarterly Color Team Meeting Noon conference: all clinic staff, residents and faculty will be engaged in this process and will meet in their pre-assigned color pod groups. During these sessions, objectives will vary based on quarter as indicated below. The goal will be to complete 2 PDSA cycles annually as a cohort. Faculty leads will take notes and disburse to the entire team to include those who are not present for the meeting.
- Quarter 1: Identify a measurable goal to accomplish in the next PDSA cycle (PD)
- Quarter 2: Review results of Q1 PDSA cycle (SA)
- Quarter 3: Identify a measurable goal to accomplish in the next PDSA cycle (PD)
- Quarter 4: Review results of Q3 PDSA cycle (SA)
Appendix C
The clinic committee is comprised of pre-assigned PGY1, PGY2, PGY3 residents, the Clinic Director, the Clinic Manager and faculty members. Assignment of residents to the clinic committee will vary annually. The goal of the clinic committee is to discuss areas for improvement within the clinic and thus they will play a key role in identifying future potential projects that can be undertaken by the color pod teams. They also will review and maintain projects. Leadership of this committee will ultimately be responsible for entering projects into the Residency Performance Improvement Program (ResPip) system.
