Background & Motivation Systems Engineering Collaboration to Analyze Internal Medicine Residency James Benneyan1, Margo Jacobsen1, Awatef Ergai1, Mohit Shukla2, Paul Han2, Leo Waterston2, Jordan Peck2, Daniel Meyer2, Laurie Burton2, Thomas Van der Kloot2, Robert Bing-You2, Peter Bates2 1Healthcare Systems Engineering Institute, Boston, MA; 2Maine Medical Center, Portland, ME Objective Overall: Redesign interprofessional clinical learning environment to improve (1) care quality, (2) learning outcomes, and (3) provider well-being & satisfaction Project Specific: Analyze current state of graduate medical education (GME) in an internal medicine residency program from a systems engineering perspective Methods & Results Interviews & Observations Conducted 27 semi-structured 1-on-1 and group interviews Shadowed care team members (residents, nurse, care manager) Macro-Ergonomic Work Context Education barriers: Lack of time for reflective learning, fatigue due to duty hours and heavy workloads, and variable training Patient safety barriers: Lack of interdisciplinary communication/teamwork Cross Functional Process Flow Maps & Time Studies Understand stakeholder workflows and identify potential bottlenecks and delays Analyze how residents spend time and variation between residents and days Study actual work patterns (“work-as-done”) vs. process plans (“work-as-imagined”) Partners MMC Internal Medicine residency program Healthcare Systems Engineering Institute (Boston, MA) Expertise in design and analysis of complex systems of systems Systems Engineering Initiative for Patient Safety (SEIPS) is a framework for studying larger work context (enablers and barriers) Background & Motivation Healthcare has changed dramatically, but GME remains much the same Physicians and medical students suffer high rates of depression and burnout Medical students: 27% depression prevalence, 11% suicidal ideation [1] Over 54% physicians experience ≥1 burnout symptom in 2014 [2] Failure Analysis Identified 18 failure modes, with 21 effects and 43 causes Team identified more care-related failures (13) than learning-related failures (5) and rated them with much higher severity Poor communication amongst different medical disciplines, and between providers and patients is the most common severe failure. vs. vs. High variation of practices from day-to-day and person-to-person Significant fragmentation of daily schedule 12-17% time spent with patients 1-5% time spent communicating with nurses 24-28% time spent in medical team discussion Functional Resonance Analysis Method (FRAM), Functional Interdependencies Providing patient care is the most interconnected function Communication is critical in achieving learning outcomes and accomplishing daily activities Failure mode effects analysis (FMEA) is a reliability engineering design tool that identifies and prioritizes potential failures by severity, frequency, and preventability Accreditation Council for Graduate Medical Education (ACGME) study Significant variation in resident training across United States ACGME funded 8 academic medical centers to develop innovative, collaborative solutions and approaches that can be spread nationally MMC funded to develop and implement the iPACE patient unit: Interprofessional Partnership to Advance Care and Education Failure categories: Communication Schedule & logistics Interruptions Conducting a failure analysis: Identify failures and causes/effects of these failures Assign severity and frequency scores (1-10) Calculate criticality = severity x frequency Prioritize failures in order of highest to lowest criticality Functional Resonance Analysis Method (FRAM) is a systems science tool from the “Safety-II complexity” field Current Work Evaluate resident workflows in newly-established iPACE unit Analyze frequency and sources of interruptions in iPACE vs. other patient care units Investigate how informal learning occurs on units by observing and recording teachable moments Study nurse workflows, failures, and interruptions Future Work Spread learnings and best practices to other departments and hospitals Evaluate impact of improved interprofessional learning on patient outcomes and costs Overall Findings Identified barriers and challenges in interprofessional education: Work burden and strains on time Interruptions and fragmentation in work flows Lack of communication between disciplines Scheduling and logistical barriers [1] Rotenstein et al. Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Med Students. JAMA. 2016. [2] Shanafelt et al. Changes in burnout and satisfaction with work-life balance in physicians and the general US working population between 2011 and 2014. Mayo Clin Proc. 2015. Northeastern University © 2017 www.coe.neu.edu/healthcare Healthcare Systems Engineering Institute The project described was supported by National Science Foundation award #1034990 and the Accreditation Council for Graduate Medical Education (ACGME) . The contents of this poster are solely the responsibility of the authors and do not necessarily represent the views of the National Science Foundation, ACGME, nor any of their agencies. The research presented here was conducted by the awardee.