Integrating healthcare quality into the Internal Medicine resident training curriculum has been a focus of our institution’s Educational Innovations Program of the ACGME. Five years ago, at Baystate Medical Center we began a PGY2 two week block rotation called ‘Tracer’, which assigns a resident as the Quality Officer on a ward team. The early focus of the tracer was benchmarking hospital standards of care around core measures as defined by CMS for their team and identifying errors in transition with emphasis on post acute care. This year we shifted the focus of the curriculum to one of waste and failure identification and reduction.
To build a curriculum that enhances resident education by exposing them to the principles of waste reduction and systems failure identification.
First, we developed the waste and failure identification worksheet by modifying the IHI toolkit. We employed the principles of Lean by incorporating the seven wastes into the toolkit. The tracer resident implemented the toolkit on ward bedside rounds. The ward team consists of two interns, a resident and an attending. The team rounds daily on multiple floors of the hospital and sees about 12 patients over a 2hour period. The bedside rounds include the patient’s nurse and case manager if they are available. The toolkit is applied daily to assess and document for waste and systems failure in patient care. If there are obvious errors these are discussed with the team at the time of discovery. Weekly tracer rounds are held with each tracer to review the week’s work, experience and data. Enhancements are made to the toolkit with input from the tracer resident. Residents have learned key themes about waste such as motion and transport waste (patients as well as providers), quality impact/defects (such as failures when hospital acquired infections occur, medication errors, and code blues), over processing (i.e., overuse error with labs and radiology), inventory (right supplies for the right procedure), and waiting (such as placement to facilities or waiting for tests).
Our goal is to expose residents to IOMs aims of safe, effective, equitable, efficient, timely and patient centered care with waste and systems failure as the central theme. With this new waste and failure curriculum residents are more engaged in understanding the concepts of quality care. Changing behavior with concepts of waste reduction, systems failure identification with process improvement and quality care is imperative in molding the next generation of physicians to practice in an everrestrictive healthcare environment because of ballooning cost.
To cite this abstract:Paadam J, Meade L, Shaaban R, Kleppel R, Yadav S. Embedding the Concepts of Waste and Systems Failure Reduction in an Innovative Quality Curriculum for Resident Education. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97730. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/embedding-the-concepts-of-waste-and-systems-failure-reduction-in-an-innovative-quality-curriculum-for-resident-education/. Accessed May 23, 2019.