Increasing Resident and Staff Comfort with QI: Lessons Learned with the Implementation of a New QI Curriculum Carilion Clinic - VTC SOM FMRP Aarti Aggarwal, MD Eric Chen, MD Lauren Penwell-Waines, PhD James Thompson, MD

Disclosures none to report

Objectives Learn how to design and institute a quality improvement (QI) curriculum similar to the one modeled here. Describe several potential barriers and challenges in attempting to teach QI to residents and staff. Design a simple, easily administered survey to determine the self-assessed comfort level of their program residents, staff, and faculty with QI.

Quality Improvement Dilemma became a PCMH under 2008 criteria no formalized QI curriculum increased importance of Population Health Management from our system and insurers

Solution Formalized QI curriculum, 7/2013 – 6/2014 monthly hour-long lectures at resident education conferences bi-monthly education and emphasis for full staff including residents at “Practice Innovation” meetings PGY3 QI year-long projects all centered on decreasing ED utilization

Pre and Post-Implementation Survey 8 questions (1 identifier, 7 substance) 5 possible responses not at all familiar not very familiar/comfortable somewhat familiar/comfortable very familiar comfortable completely familiar/comfortable

Pre and Post Implementation Survey Are you: (Faculty, Resident, or Staff)? How familiar are you with the process of quality improvement (QI)? How familiar are you with Plan-Do-Study- Act (PDSA) cycles as a QI tool? How familiar are you with the core principles of PCMH?

Pre and Post-Implementation Survey Are you comfortable designing and implementing a QI project? Are you comfortable designing and implementing a PDSA cycle? How comfortable are you with your role(s) within a care team performing QI? How comfortable are you with implementing QI and PDSA cycles in your practice after residency?

Structured QI Curriculum Topics core principles of PCMH PDSA cycles A3 problem solving method (Lean Healthcare) practice scorecard metrics and Population Health Management

Structured QI Curriculum Topics Fishbone diagram root cause analysis tool focus on PGY3 QI projects ABFM MOC QI emphasis and mid-year quiz PGY3 presentations of their QI (Research and Scholarly Activity) projects

Faculty Data 4.7 4.8 4.5 4.3 Mean rating (0-5)

Resident Data 3.4 3.4 3.3 3.4 3 Mean rating (0-5) 2.7 2.1 1.9 1.6 1.5

Staff Data 3 3.1 2.9 Mean rating (0-5) 2.8 2.4 2.1

Lessons Learned Pros formalized curriculum was effective in raising knowledge and comfort positive anectodal feedback from PGY3s on the interview trail for jobs alignment of practice scorecard metrics, PGY3 QI projects, and I3 Collaborative goal was a practice unifier

Lessons Learned Cons (major resident dissatisfiers) time investment in process education, rather than content tightly-restricted options for PGY3 QI projects

PDSA Round 2, 7/2014 – 6/2015 eliminated the monthly QI process education sessions eased restrictions on PGY3 QI project topic primarily using the bi-monthly full staff meetings to communicate QI terminology and concepts

Questions and Discussion Permission received to use the photograph from subjects.

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