QI – Systems-based Practice

Cynthia Ferrell, MD, MSEd

Javier Gonzalez del Rey, MD, MEd
Systems-based Practice

 Definition:
– “Residents must demonstrate an awareness of
and responsiveness to the larger context and
system of health care, as well as the ability to call
effectively on other resources in the system to
provide optimal health care.”
Systems-based Practice

 Residents are expected to:

– Work effectively in various health care delivery settings and
systems

– Coordinate patient care

– Incorporate consideration of cost awareness and risk-

benefit analysis
Systems-based Practice

 Residents are expected to:

– Advocate for quality and optimal patient care

– Work in interprofessional teams to enhance patient safety

and improve patient care quality

– Identify system errors and implement potential solutions

Quality Improvement

Isn’t this the same thing???

What’s the difference

Systems-Based Practice Quality Improvement

 A competency  An expectation for PBL

competency
 Could be used to meet
SBP competency
What is required for QI?

 Residents must be mentored in quality improvement

skills

 Residents should systematically analyze practice

using quality improvement methods, and implement
changes with the goal of practice improvement

 Residents are expected to participate in a quality

improvement project
What does the PIF ask about SBP?

 Describe the learning activities through which

residents will achieve competence in the elements of
systems-based practice (400 words):

Examples of such activities would include: work effectively in

various health care delivery settings and systems,
coordinate patient care within the health care system;
incorporate considerations of cost-containment and risk-
benefit analysis in patient care; advocate for quality patient
care and optimal patient care systems; and work in
interprofessional teams to enhance patient safety and care
quality.
What does the PIF ask?

 Describe an activity that will provide experiential

learning in identifying system errors (400words):

 Identify who guides/supervises residents in this

activity (75 words):
What does the PIF say about QI?

 Give one example and the outcome of a planned

quality improvement activity or project in which at
least one resident participated in the past year that
required the resident to demonstrate an ability to
analyze, improve and change practice or patient
care. Describe planning, implementation, evaluation
and provisions of faculty support and supervision
that guided this process (limit your response to 400
words).
How can your program meet these
requirements?
Some “best practices”:

 Family centered rounds

– Work in interprofessional teams
– Direct observation of Competencies
– Family Centered Rounds Website
http://www.cincinnatichildrens.org/about/fcc/rounds/

 Structured M & M Conferences

– Advocate for quality patient care and optimal patient care
systems
– Risk benefit analysis
Some “best practices”:

 Serious Safety Event – Root Cause Analysis

 Patient safety net reports/incident reports
 Patient Care Conferences
– coordinate patient care within the health care system
 QI training and practice for residents
– enhance patient safety and care quality
Resource

 ACGME Notable Practices

 APPD Share Warehouse

 Learning Structure: “QI at CCHMC Residency”
Global Aim
By June, 2009, all graduating
residents have the knowledge
and skills to use Quality
Improvement methods to
improve care and outcomes.
(Annual follow-up surveys will
demonstrate use of QI in
practice).
Outcome
Graduating residents have skills
to identify gaps and address
changes to improve care and
outcomes using improvement
science
Design Changes
Residency program director
participates in Improvement Training
Key Drivers (e.g. pilot projects :obtain parent
feedback as part of resident
evaluation, “Night Talks”
Quality Improvement communication project)
methodology is used to
improve specific educational Chief resident ( focus on QI).
Use various modalities to highlight
goals for the Residency
resident safety project, measures,
program
and tests of change: Thursday
morning systems conference, M&M
conference, chart on wall (where?)
Residency Program builds website postings.
focus on Quality/Safety into
rhythm of educational Resident co-lead high profile safety
curriculum. project with Patient Safety Officer
Focus on specific topic; develop key
driver diagram, measures, changes
and test
Hospital highlights residents’ key role
Key leaders in the
(as part of team)
Residency Program serve in
Residency program director
leadership roles relating to completes Improvement Training;
Quality and Safety. mentors residents; bring on new
(e.g. on strategic faculty member to mentor
Improvement/Safety Teams)
QI Fundamentals workshop
QI Fundamentals online module
Gain Key QI knowledge M & M conferences
during residency Change the outcome noon
conferences
Sufficient faculty with QI experience
available to mentor residents.
 University of Rochester
Pediatrics and Med Peds

 PL – II
– 2 weeks block
– Workshops hands on
– QI and Safety Theory
– Develop projects by end of sessions
– Faculty Development – Mentorship is important

“Most chose projects in clinic/practice, but ICU, ED, NICU and

floors have all benefitted as well as 'resident' driven issues (NICU
call / handovers / discharge summary info., etc.)”
 UNC Children’s Hospital
Levine Children’s Hospital

 Progressive Curriculum
– Reading – Didactics- Online
– Close mentorship
– Practical Projects
– Adds new levels as residents progress
– Support from Program Leadership
– Faculty Development / Mentorship
“Residents selected projects such as Family
Centered Rounds, increasing exercise,
finding a quicker route to work, decreasing
spending on food, and streamlining children’s
bedtime routine.”
 Oregon Health & Science
University

 Residency-wide QI projects
– AAP/OPS/Doernbecher Collaborative Asthma
Quality Improvement Project
 Practices throughout state
 Utilizes EQUIPP
 Resident “credit” and attending MOC credit
– OHSU Pediatric Residency Project
 Monthly meetings to plan and implement resident project
 Problem list completion and maintenance

Project is mentored by Residency Program

Director and the Director of QI for Doernbecher
Remember…

 Knowledge curriculum
 Practice – Hands on experience
 Measure – Direct Observation
 Document – document – document!
Thank You!