Order from Chaos: Improving Quality of Care in a Resident/Faculty Practice Through Integrated Team Meetings Jennifer Leiser, MD, Sonja Van Hala, MD, MPH, Bernadette Kiraly MD, Richard Backman, MD Family Medicine Division, Department of Family and Preventive Medicine, University of Utah Salt Lake City, UT, USA Background Results: Quality Indicators Results: Team Development Results: Participant Evaluations The Team Development Measure (TDM) quantifies team effectiveness. Administered in August 2009 and November 2011. Quality indicators for our resident/faculty clinics were stagnant. Barriers to quality improvement were lack of time to meet, insufficient training in clinic processes, and undeveloped teams. Resident Continuous Quality Improvement (CQI) project teams lacked meeting time. Most Helpful: Information on topics Team meetings Action oriented with practical solutions Information on CQI process and quality Personal story about disease impact   Recommendations: Coordinate processes across teams Follow up data to see impact and effect of work Stay on time and complete agendas Add patient perspective on quality Methods In July 2011 we implemented a monthly meeting to focus on quality and team building. All faculty, residents and staff of the clinics participate. In November 2011 we measured quality indicators, measured effect on team process, and collected participant evaluations. 2009 mean score=50 2011 mean score=60 p= 0.0027 Conclusions Stages of Team Development Stage Score Range Components Present Solidification Pre-Team 0 - 36 None to Building Cohesiveness - 1 37 - 46 Cohesiveness In Place 2 47 - 54 Communication 3 55 - 57 Role Clarity 4 58 - 63 Goals & Means Clarity 5 64 - 69 Firmly In Place 6 70 - 77 7 78 - 80 8 81 - 86 Fully Developed 87 - 100 Everything Preliminary conclusions after 4 months: Quality indicators trending upward. It is too early to tell how much can be attributed to quality meeting. We noted tendency for indicators to move in parallel. As teams paid more attention to the process for the month, they also addressed other processes. For example, working BPA for Pneumonia Vaccination led to working BPA for other preventive measures. Team development shows improvement. Participant evaluations generally positive. Scholarly outcomes include a major grant submission and several anticipated conference presentations.  Resident CQI Projects are now hardwired into our clinic process. Meeting Schedule 8:00-8:50 Clinic Quality Update Topic introduction Personalized story Present clinic level quality reports Explanation of metrics Best Practice Alerts (BPA) 9:00-9:30 Clinic Business Meeting 9:30-10:10 Clinic Team Meetings Review individual provider data for team Decide on team improvement goal Create action plan with assignments 10:30-11:30 CQI Team Meetings Resident-led projects linked to CQI curriculum FOCUS-PDSA methodology 11:30-12:30 Practice Improvement Work Groups Maternity Care Practice Enhancement Chronic Pain Management Resident Procedure Scheduling In-basket Standardization Interpretation: the teams have advanced from stage 2 to stage 4 during this time frame. Monthly Topics July: Pneumonia Vaccination August: Diabetes September: Influenza Vaccination October: Breast Cancer Screening November: Colon Cancer Screening References and Acknowledgements The Team Measure. Sacred Heart Medical Center, 2007. http://www.peacehealth.org/about-peacehealth/medical-professionals/eugene-springfield-cottage-grove/team-measure/Pages/Default.aspx Accessed 9-27-2011 This presentation was approved by the Institutional Review Board of the University of Utah, IRB 00050403. Special thanks to Rick Henriksen, M.D. and Katherine Fortenberry PhD for statistical assistance. Special thanks to the staff and managers of the Madsen and Sugarhouse clinics for their participation and cooperation with this study.