OhioHealth Riverside Methodist Hospital, Columbus, OH
Find It, Fix It: Engaging Residents and the C-Suite in Quality Improvement

Abstract

Background: The ACGME CLER program calls for residents to participate in quality improvement/patient safety initiatives. However, our institutional quality improvement/patient safety initiatives rarely involved trainees and there was little education/participation in quality improvement/patient safety at the GME level. This gap highlighted an opportunity for engaging residents and the C-suite in a shared quality improvement initiative.

Methods: A planning committee that included residents, faculty members, GME staff, nursing, the vice president of Medical Affairs, and the vice president of Quality was formed in October 2013. The Find It, Fix It quality improvement project was developed using a Kaizen process board approach and kicked off in February 2014. Residents were encouraged to submit idea cards when they identified opportunities for improvement. The C-suite, GME staff, and faculty met weekly to review the central board and help residents fine tune their ideas and facilitate the projects. After residents learned quality improvement in a hands-on fashion by working through PDSA cycles, a survey of knowledge and attitudes based on the Continuous Quality Improvement Questionnaire and Quality Improvement Knowledge Application Tool pretest was administered to academic year 2013–2014 trainees preproject (2/2014), at 4 months (6/2014), and at 12 months (2/2015) and also to incoming academic year 2014–2015 interns (6/2014) and at 7 months (2/2015). Overall metrics and metrics for the individual residency programs were tracked, including the number of idea cards submitted, the number of projects started, the number of projects completed, types of projects, and the number of residents involved.

Results: A total of 124 ideas were submitted by 72 residents, and 71 projects were initiated. Of those 71 projects, 36 were quality improvement/patient safety and patient focused. Thirty-two projects were completed: 10 projects led to improvement in patient care quality, 18 projects led to equipment/storage improvement, 1 project led to improvement in education/training, and 3 projects were accepted for national presentations (as of 2/2015). A total of 97, 106, and 125 residents completed the presurvey, the survey at 4 months, and the 12-month postsurvey, respectively. In the 12 months prior to the project, 40% of residents were involved in at least one quality improvement project, while 87% were involved during the first 12 months of the initiative. A total of 45 residents completed all 3 surveys. Knowledge of quality improvement improved, and lack of knowledge was felt to be less of a barrier. However, interest in quality improvement decreased from baseline to postsurvey, and measures of attitude toward quality improvement did not improve.

Conclusions: Find It, Fix It was a successful initiative to engage residents and the C-suite in quality improvement. The Kaizen approach allowed widespread exposure to and involvement in quality improvement. Sustainability of this large project will require significant time and effort for faculty. A GME-led quality initiative can spur culture change around quality improvement within residency programs and create opportunities to showcase medical education at the institutional and organizational level.