1. Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH, FAAFP Residency Program Director University of Utah Program Director’s Retreat September 24, 2015

2. QI Requirements for Residents in Every Specialty Residents are expected to: “systematically analyze practice using quality improvement methods, and implement changes with the goal of practice improvement” Accreditation Council for Graduate Medical Education. Common program requirements. Available at: http://www.acgme.org/acgmeweb/Portals/0/PFAssets/ProgramRequirements/CPRs2013.pdf. Accessed March 11, 2015. 2

3. Goal: Exceptional Value

4. 4

5. Objectives  Background of the quality curriculum in Family Medicine Residency Program  Methods used to create a culture of quality  Outcomes of a quality culture  Future opportunities

6. Background Clinic quality metrics plateaued QI projects showed limited long-term impact Scholarship was not linked to work on quality

7. Curriculum Overview Longitudinal curriculum across academic year Structured time for resident-led quality improvement teams Leadership coaching of senior residents by faculty 7

8. Madsen Health Center Sugarhouse Health Center

9. Clinic Quality Meeting 9

10. Culture of Quality: Clinic Quality Meeting (CQM) 7:30 AM – 8:15 AMQuality OverviewVision and Strategy 8:20 AM – 9:05 AM Clinic Business Meeting Organizational Goals Safety/Environment of Care 9:10 AM – 9:40 AMClinical Team Meeting Focus on Population Health, Review Data, Action Plan 9:45 AM–10:40 AMCQI Team Meetings Resident-led & faculty mentored; All faculty, residents, and staff participate on a team 10:45 AM – 11:30 AMAd Hoc Groups Address Clinical and Educational issues

11. Third Year Resident as Team Leader

12. “Just in Time Teaching” QI Curriculum July Aug Sept Oct Nov Dec Jan Feb Mar Apr May June FOCUS-PDSA Methods, Leadership Skills CLINIC QUALITY MEETING SEMINAR Presentations FOCUS-PDSA Application Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.The Improvement Guide: A Practical Approach to Enhancing Organizational Performance

13. Childhood Vaccination Madsen Family Health Center (2011): 66% Aim: Improve vaccination rate to 90% for children under age 2 Intervention : Daily printed vaccine report for each child scheduled in clinic Distribute report to providers in huddle Improved to 92% over the five month intervention Three years later, improvement was sustained

14. Culture of Quality: The Role of Faculty Expectation of faculty engagement Quality Champions –Chief Value Officer –Curriculum Director Seminar instructors Team advisor Team member

15. Culture of Quality: Resident Roles R1: Observation/Participation R2: Team member R3: Team leader 15

16. 16

17. Resident–Led QI Teams Community Clinics Operational Goals 2015 HEDIS Measure Clinical and Research Priority Diabetes Mellitus control Hba1c < 9.0 XX HTN control XX Chlamydia Screening XX Childhood Immunization X Adult Immunization XX QI Projects for 2015-2016

18. Family Medicine 2013 Apr;45(4):235-9. Outcome – Optimizing Research Educational Actualization Clinical Transformation

19. Childhood Vaccination Madsen Family Health Center (2011): 66% Aim: Improve vaccination rate to 90% for children under age 2 Intervention : Daily printed vaccine report for each child scheduled in clinic Distribute report to providers in huddle Improved to 92% over the five month intervention Three years later, improvement was sustained

20. 20

21. 21

22. 2015 QI Scholarship Hypertension Control Enrollment in Chronic Pain Pathway Pneumococcal Vaccination in Adults Physical Activity Counseling in Children Chlamydia Screening Hemoglobin A1c Childhood Immunizations Asthma 22

23. 2015 QI Scholarship Hypertension Control Enrollment in Chronic Pain Pathway Pneumococcal Vaccination in Adults Physical Activity Counseling in Children Chlamydia Screening Hemoglobin A1c Childhood Immunizations Asthma 23 Annual Spring Conference April 2015

25. 2015 QI Scholarship Hypertension Control Enrollment in Chronic Pain Pathway Pneumococcal Vaccination in Adults Physical Activity Counseling in Children Chlamydia Screening Hemoglobin A1c Childhood Immunizations Asthma 25 Evidence Based Practice Fair May 2015

26. 2015 QI Scholarship Hypertension Control Enrollment in Chronic Pain Pathway Pneumococcal Vaccination in Adults Physical Activity Counseling in Children Chlamydia Screening Hemoglobin A1c Childhood Immunizations Asthma 26 70 th Annual Conference May 2015

27. 2015 QI Scholarship Hypertension Control Enrollment in Chronic Pain Pathway Pneumococcal Vaccination in Adults Physical Activity Counseling in Children Chlamydia Screening Hemoglobin A1c Childhood Immunizations Asthma 27 CCC (Community Clinics Council) Quality Committee June 2015

28. 2015 QI Outcomes Chlamydia Screening –5% increase with patient education, provider prompts Hemoglobin A1c –Proactive scheduling of appointments improved A1c Enrollment in Chronic Pain Pathway –Identification system improved enrollment 18% 28 ✔ ✔ ✔

29. 29 2012 STFM Family Practice Management Award for Practice Improvement 2014 HealthInsight Quality Award

31. Adding Value I gained confidence in the role of leading a group, while learning more how to integrate the thoughts and ideas of others. –Third year FM resident My skills for leading and directing a team meeting, delegating responsibility, keeping team members accountable and most importantly engaging all team members for contributions has dramatically improved. –Third year FM resident 31

32. Dissemination University Utah Evidence-Based Practice Fair 2014, 2015 Ogden Surgical-Medical Society 2015 Society of Teachers of Family Medicine: 2011, 2012, 2013, 2014, 2015 National FM Program Directors Workshop: 2012, 2013 Ghana International Medical Seminar. Kintampo, Ghana: 2013 Clinical Quality Improvement of Family Medicine in an Aging World; Tsukuba Global Science Week. Tsukuba, Japan: 2014. 32

33. Keys to Success: Creating a Culture of Improvement Faculty champion Expectation of faculty engagement Alignment with operational goals Multidisciplinary teams Committed time for team meetings Broad leadership support 33

34. Future Directions Value Summaries Part IV Credit Program Director’s Needs Assessment 34

35. Value Summaries & Part IV Credit Insert picture of a value summary 35

36. Program Needs Assessment Please complete 5 minute PD survey Inform the development of a foundational QI curriculum, exportable to GME programs 36

37. Leveraging QI to 3 Missions Skate to where the puck is going to be, not to where it has been. Wayne Gretzky susan.pohl@hsc.utah.edu sonja.vanhala@hsc.utah.edu 37