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Levy KL, Grzyb K, Heidemann LA, Paliani DB, Grondin C, Solomon G, Spranger E, Ellies T, Ratz D, Houchens N. Enhancing Resident Education by Embedding Improvement Specialists Into a Quality and Safety Curriculum. J Grad Med Educ 2023; 15:348-355. [PMID: 37363669 PMCID: PMC10286907 DOI: 10.4300/jgme-d-22-00456.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 10/19/2022] [Accepted: 02/27/2023] [Indexed: 06/28/2023] Open
Abstract
Background Quality improvement and patient safety (QIPS) curricula are critical in graduate medical education, yet barriers limit the educational experience and project outcomes. Objective To explore the impact of QIPS curricular enhancements and integration of continuous improvement specialists (CIS) by examining the A3 document, the primary project product and surrogate for project quality. Methods Since 2009, University of Michigan internal medicine and medicine-pediatric residents participate in a QIPS curriculum, which includes a 4-week group project. In 2016, residency leaders collaborated with CIS staff, non-clinical experts in QIPS with backgrounds in engineering and business, to improve the curriculum. Informed by a needs assessment, the intervention was implemented in 2017 and consisted of a set of enhancements including integration of CIS staff into groups as co-facilitators. In this retrospective cohort study, a blinded reviewer evaluated all available A3 documents before and after the intervention using a quantitative analysis tool. Results All residents participated in the curriculum during the pre-intervention (July 2009 to June 2016, n=351) and post-intervention (July 2017 to June 2020, n=148) periods. A total of 23 of 84 (27%) pre-intervention and 31 of 34 (91%) post-intervention A3 documents were available for review. Scores improved significantly for 17 of 23 (74%) A3 items and for 7 of 8 (88%) sections. Mean A3 total scores increased from 29.0 to 47.0 (95% CI 12.6-23.4; P<.001) out of a possible 69.0. Conclusions Embedding CIS experts into residency QIPS curricula is associated with improved A3 document quality.
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Affiliation(s)
- Kathryn L. Levy
- Kathryn L. Levy, MD, is Assistant Professor, Departments of Internal Medicine and Pediatrics, and Associate Program Director, Internal Medicine and Pediatrics Residency, University of Michigan
| | - Katie Grzyb
- Katie Grzyb, BSE, MHSA, is Continuous Improvement Specialist, Department of Internal Medicine, University of Michigan
| | - Lauren A. Heidemann
- Lauren A. Heidemann, MD, MHPE, is Associate Professor, Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System
| | - Debra Burke Paliani
- Debra Burke Paliani, MSME, is Continuous Improvement Specialist, Quality Department, University of Michigan Health System
| | - Christopher Grondin
- Christopher Grondin, MD, is Assistant Professor, Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System
| | - Gabriel Solomon
- Gabriel Solomon, MD, is Assistant Professor, Department of Internal Medicine, University of Michigan and Veterans Affairs Ann Arbor Healthcare System
| | - Elizabeth Spranger
- Elizabeth Spranger, BA, is Continuous Improvement Specialist, Department of Internal Medicine, University of Michigan
| | - Tammy Ellies
- Tammy Ellies, MBA, PMP, is Continuous Improvement Specialist, Department of Internal Medicine, University of Michigan
| | - David Ratz
- David Ratz, MS, is Statistician, Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System
| | - Nathan Houchens
- Nathan Houchens, MD, is Associate Professor, Department of Internal Medicine, and Assistant Program Director, Internal Medicine Residency Program, University of Michigan and Veterans Affairs Ann Arbor Healthcare System
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Ojo B, Feldman R, Rampersad S. Lean methodology in quality improvement. Paediatr Anaesth 2022; 32:1209-1215. [PMID: 35302676 DOI: 10.1111/pan.14439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 11/27/2022]
Abstract
Measurement of quality and improvement in medicine has existed since Florence Nightingale's time. In modern times, medicine has sought to learn from other high-reliability industries such as aviation and nuclear power, where errors can result in catastrophic outcomes. Lean is a unique quality improvement strategy that seeks to improve both quality and safety by driving out waste and, where possible, standardizing work practices. It is a visual system with work aids and signals built into the workspace. An important tenet is that ideas come from the workers and that there is an iterative improvement. The improvement efforts are always viewed from the perspective of the customer, our patients, families, and coworkers. This paper describes the evolution of Lean in healthcare and highlights core principles of Lean. Examples are used to describe how various Lean tools can be applied by pediatric anesthesiologists to solve clinical problems.
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Affiliation(s)
- Bukola Ojo
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel Feldman
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington, USA
| | - Sally Rampersad
- Seattle Children's Hospital and University of Washington School of Medicine, Seattle, Washington, USA
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Mayo AL, Wong BM. Starting off on the right foot: providing timely feedback to learners in quality improvement education. BMJ Qual Saf 2021; 31:263-266. [PMID: 34551994 DOI: 10.1136/bmjqs-2021-013251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/21/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Amanda L Mayo
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Brian M Wong
- Centre for Quality Improvement and Patient Safety (CQuIPS), Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada .,Division of General Internal Medicine, Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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