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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

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Page 1: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Foundational Resident Training in Quality: Alignment Leads to Results

Susan Pohl, MDDirector of Quality Improvement Curriculum

Sonja Van Hala, MD, MPH, FAAFPResidency Program Director

University of Utah

Program Director’s Retreat

September 24, 2015

Page 2: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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.

Page 3: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Goal: Exceptional Value

Page 4: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Page 5: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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

Page 6: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Background

• Clinic quality metrics plateaued• QI projects showed limited long-term

impact • Scholarship was not linked to work on

quality

Page 7: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Curriculum Overview

• Longitudinal curriculum across academic year

• Structured time for resident-led quality improvement teams

• Leadership coaching of senior residents by faculty

Page 8: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Madsen Health Center

Sugarhouse Health Center

Page 9: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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ClinicQualityMeeting

Page 10: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Culture of Quality:Clinic Quality Meeting (CQM)

7:30 AM – 8:15 AM Quality Overview Vision and Strategy

8:20 AM – 9:05 AM Clinic Business MeetingOrganizational GoalsSafety/Environment of Care

9:10 AM – 9:40 AM Clinical Team MeetingFocus on Population Health, Review Data, Action Plan

9:45 AM – 10:40 AM CQI Team MeetingsResident-led & faculty mentored; All faculty, residents, and staff participate on a team

10:45 AM – 11:30 AM Ad Hoc Groups Address Clinical and Educational issues

Page 11: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Third Year Resident as Team Leader

Page 12: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

“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.

http://www.ihi.org/resources/Pages/Publications/ImprovementGuidePracticalApproachEnhancingOrganizationalPerformance.aspx
Page 13: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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

Page 14: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Culture of Quality:The Role of Faculty

Expectation of faculty engagement• Quality Champions

– Chief Value Officer– Curriculum Director

• Seminar instructors• Team advisor• Team member

Page 15: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Culture of Quality:Resident Roles

• R1: Observation/Participation• R2: Team member• R3: Team leader

Page 16: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Page 17: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Resident–LedQI Teams

Community Clinics

Operational Goals 2015

HEDIS Measure

Clinical and Research

Priority

Diabetes Mellitus control Hba1c < 9.0 X X

HTN control X X

Chlamydia Screening X X

Childhood Immunization X

Adult Immunization X X

QI Projects for 2015-2016

Page 18: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

Family Medicine 2013 Apr;45(4):235-9.

Outcome – OptimizingResearch

Educational Actualization

Clinical Transformation

Page 19: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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

Page 20: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Page 21: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Page 22: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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

Page 23: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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

Annual Spring ConferenceApril 2015

Page 24: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,
Page 25: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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

Evidence Based Practice FairMay 2015

Page 26: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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

70th Annual ConferenceMay 2015

Page 27: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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

CCC (Community Clinics Council) Quality CommitteeJune 2015

Page 28: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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%

✔

✔

✔

Page 29: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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2012 STFM Family Practice Management Award for Practice Improvement 

2014 HealthInsight Quality Award

Page 30: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,
Page 31: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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

Page 32: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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.

Page 33: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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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

Page 34: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Future Directions

• Value Summaries • Part IV Credit• Program Director’s Needs Assessment

Page 35: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Value Summaries & Part IV Credit

Insert picture of a value summary

Page 36: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Program Needs Assessment

• Please complete 5 minute PD survey• Inform the development of a foundational

QI curriculum, exportable to GME programs

Page 37: Foundational Resident Training in Quality: Alignment Leads to Results Susan Pohl, MD Director of Quality Improvement Curriculum Sonja Van Hala, MD, MPH,

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Leveraging QI to 3 Missions

Skate to where the puck is going to be, not to where it has been.

Wayne Gretzky

• [email protected]• [email protected]

mailto:[email protected]
mailto:[email protected]
mailto:[email protected]
mailto:[email protected]

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