1. Teaching & Mentoring Residents & Fellows in Quality Improvement GME Symposium October 3, 2014 Curriculum Development & Planning Slides Jennifer Myers MD

2. What is the ACGME Looking for? “Top” of the Pyramid Miller’s Pyramid for Learner Assessment

3. “Milestone” Reporting A Sample from a QI Milestone Reporting Worksheet Applies performance improvement methodologies Participates in process improvement to optimize ED practice #20. PBLI: Participates in performance improvement to optimize ED function & pt care

4. Yeah…But What About My Specialty? General Surgery The resident performs basic steps in a QI project Internal Medicine & Medicine Subspecialties Actively engages in quality improvement initaitives Demonstrates the ability to apply common principles & techniques of QI to improve patient care for a panel of patients Radiation Oncology Able to define and construct process & outcomes measures of quality Designs & completes a QI project

5. Common Questions Do trainees need to be “doing” QI every year of their training? – NO Does each trainee need to lead their own separate project? – NO How much active participation does each trainee need to have in the QI project? – We don’t know. The ACGME has not defined this…

6. Curriculum Development Process Kern’s 6-Steps Problem Identification & General Needs Assessment Needs Assessment of Targeted Learners Goals & Objectives  Educational Strategies  Implementation  Evaluation & Feedback

7. Step By Step Approach Educational Strategies Implementation Step 3: Project Management Step 2: Project Selection Step 1: Make a Plan

8. Step By Step Approach Educational Strategies Implementation Step 1: Make a Plan Step 2: Step 3:

9. Step 1: Make a Plan (aka: Educational Strategies) Who will teach the content? – Teacher Options: You! You + one of us to co-teach & facilitate How? – Format Options Teach content all at once Flipped Classroom Teach content piecemeal for just-in-time learning & use Think about involving non-housestaff in the activity (faculty, nurses, other staff) When?

10. Step 1: Make a Plan (aka: Educational Strategies) What level of learner will you involve? Who will guide them longitudinally through the project? Who is not here that you can potentially enlist to help?

11. Step 1: Make a Plan Project Organization Options Option 1: Several Trainees (2 -10) = One “Program” Project Option 2: Many Trainees (>10) = One project “handed off” or more 2 or more program projects Option 3: One Trainee = One Project

12. OK – Make a Plan! 10 minute Activity Take a few minutes to fill out the top of the worksheet grid. If you are here with others in your program, you should work on it together

13. Step By Step Approach Educational Strategies Implementation Step 1: Start to Plan Step 2: Project Selection Step 3:

14. Step 2:Project Selection Perhaps the most important decision you will help your trainees to make Think small and doable, not big and complex – SCOPE Think about the “A” (ACHIEVABLE) in SMART goal Look for projects that align with division, departmental, hospital, or clinic quality goals – Think about the “R” (RELEVANT) in SMART goal A project that is just starting in your division/dept that the trainees can join Something that interests the residents or fellows

15. Step 2: Project Selection “ Top-Down” vs “Bottom-Up” Approach to Project Selection

16. Step 2: Project Selection Who needs to approve? – Division/Department leadership – We in CEQI are working on a process for this Who needs to be informed? – Stakeholder Analysis: develop a communication plan

17. Step By Step Approach Educational Strategies Implementation Step 1: Start to Plan Step 2: Project Selection Step 3: Project Management

19. Assume trainees know nothing (and I mean nothing) about managing a project and running meetings

20. You Will Need to Make Connections for the Residents & Fellows One success factor for trainee QI projects is faculty mentors who have local system knowledge and deep connections within the organization* Ogrinc G, et al. Academic Medicine, 2014

21. What are we connecting the trainees to? Residents & Fellows Infrastructure Data People in our Organization

22. Is there 1 or more residents or fellows who have an interest in this area? Consider having them lead or co-lead the project Opportunities for them to get additional training – Healthcare Leadership in Quality Track Director: Neha Patel (table #6) – CHIPS Fellowship Director: Jen Myers (table #1) – Performance Improvement Training (PIIA) Chris Klock (table #7) – Masters course in QI methods (fall semester) Kathy Burke & Jen Myers – Have them attend our workshops/office hours with you

23. Proposed Timeline for Penn GME QI Curriculum TodayOctNovDecJanFebMarAprMay -> PlanningX Select a QI project areaX Problem StatementX Current Condition (baseline data, observation, process maps) X Root Causes (5 whys, pareto, fishbone) X Target Condition & Measures (SMART aim) X First Test of Change (PDSA cycle) X 2 nd, 3 rd Test of Change; Eventually make it “Standard Work” X = STOP! DID YOU DO THE “APPROVE” & “INFORM” STEPS?

24. Resources People – All of us – CEQI Staff in your division/dept/unit Tools – Everything from today & more is up on the GME website More Training Opportunities – QI “Office Hours”….more to come! – Performance Improvement in Action Curriculum – Graduate School Course in QI (fall semester) – Reading List (annotated bibliography in folders)

25. GME Quality & Safety On-Line Toolkit

26. Everything we have shown you and talked about today is here

27. Data

28. Data Resources for Quality (readily available online) Inpatient Quality Datamart -Healthcare Associated Infections -Patient Experience Scores (HCAHPS) -Patient Safety Indicators -Readmissions -CMS Core Measures -Mortality Ambulatory Analytics -Patient Access -Call Volume -New Patients Seen w/i 2 wks -Visit Data -Patient Experience -Preventative Care -Cancer screeneing -Tobacco screening/counseling -Vaccinations -Diabetes Care Indicators

29. Other Data Resources - Patient Experience – Mike Anderson -Administrative Data – Jeff Rohrbach -Cost Data – Chad Johnston -Patient Safety -Penn Medicine Safety Net – Luther Kay -Safety Culture Survey Data – Venkat Panchmanadam -Discrete SCM/EPIC data -Penn Data Store request form -GME & CEQI working together on this