1. 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

2. Disclosures
none to report

3. 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.

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

5. 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

6. 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

7. 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?

8. 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?

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

10. 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

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

12. 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

13. Staff Data
2.9
Mean rating (0-5)
2.8
2.4
2.1

14. 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

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

16. 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

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

18. Please evaluate this session at: stfm.org/sessionevaluation