Aurora Health Care, Milwaukee, WI
Creating a Culture of Quality and Safety at Aurora Health Care

Abstract

Background: The aim of this project was to pilot an approach/model that integrates and aligns Aurora Health Care (AHC) priorities (quality and safety), its existing committees/groups (Quality Committee/Council), and metrics with ACGME requirements (CLER, Common Requirements). The Residency Council was engaged in the initiative, and 3 residency programs piloted sustainable, data-driven quality/safety projects.

Methods: The family medicine project was Medication Reconciliation in Primary Care Clinics and involved a fishbone analysis to identify factors contributing to error, a focus on accurate use of the EMR, creation of a medication reconciliation workflow, training, and pre/post quizzes regarding the EMR and the workflow. The internal medicine project was 30-Day Readmissions and involved selection of a readmission risk tool and a patient perspective questionnaire, creation of a workflow and training materials, training for all team members, and a mid-project survey and medical record audit. The Ob/Gyn project was Operative Checklists in Labor and Delivery and involved the selection of checklists associated with quality care gap; delineation of team member roles and workflow; and training for faculty, residents, and students. The Residency Council was responsible for defining roles related to quality and safety, reviewing IHI modules to identify core requirements for all incoming residents, and recommending that shared noon conferences be structured to require application of quality/safety principles.

Results: All programs completed at least 1 PDSA project cycle, and all teams disseminated their results through posters and presentations. The family medicine project resulted in improved accuracy from all providers' increased awareness of the importance of the medication reconciliation workflow and of having correct medical lists. The internal medicine project increased the awareness of the 30-day readmission issue that led to changes in the discharge process, earlier mobilization of resources for challenging patients, and the increased ability of residents to identify patients at risk. The Ob/Gyn project resulted in a tremendous change in the culture and relationships among labor and delivery caregivers and providers, as well as improved care quality via checklists and smart phrases created to standardize care. The Residency Council established a charter with roles/responsibilities for quality and safety that was approved by the GMEC. The GMEC also approved the Residency Council–recommended requirement that residents and faculty complete 5 IHI modules and agreed to cosponsor a GMEC-wide shared noon conference on hand hygiene.

Conclusions: We demonstrated the impact of a sustainable 2-component model—Residency Council and program-specific NI IV teams—for engaging faculty in quality improvement initiatives aligned with AHC priorities, CLER, and RRC requirements. Next steps were identified for all 3 projects and for the Residency Council to continue to improve the clinical learning environment and ensure high quality and safe care for patients.