Presenter: Stasia Miaskiewicz, MD, FACP
Institution: UPMC McKeesport, PA
Co-Authors: T. Michael White, MD
Introduction: Shortly after our community teaching hospital and its existing residency programs merged with an academic university medical center, conditions were assessed. Within the residencies, there was ‘unhappiness’ – the resident morale was low and the residents had little sense of ownership in the hospital. Concomitantly, we recognized that our hospital, like all hospitals, was a chaotic and at times, unsafe place. Rather than ‘tweak’ the most glaring manifestations of both of these problems, a conscious decision was made to re-engineer the environment. Our goal was to create a culture within our institution where "Patient Care comes first and Graduate Medical Education comes first, too."
Our chosen target was a culture change with the goal of improving Value in Health Care (where Value equals Quality Outcomes, Customer Satisfaction, Patient Safety and Patient Autonomy balanced by Resource Utilization). We recognized that our major resource was in our people, which included our residents (residents are people, too) as they are central to the provision of Value. Therefore, as they are trained to become specialists in family practice and general internal medicine, they are also trained to become partners with and leaders of the Health Care Team in promoting a culture of patient safety.
Methods: The major focus for preparation of PGY-3 residents is a month-long rotation, ARMS (Administrative Resident Medical Service). The director of the rotation is the Senior Vice President for Value and Education (TMW). Completion of the curriculum exposes the residents to institutional procedure for improvement in safety-related areas of hospital performance. During this rotation, each PGY-3:
Teaching Patient Safety: A Curriculum for Residents in Training
- receives didactic training in Value, Quality, Patient Safety and Resource Utilization
- participates in Root Cause Analysis and Failure Mode Effects Analysis
- participates in peer review
- participates in major hospital committee meetings (P&T, Infection Control, Quality Patient Care, GME)
- participates in system-wide initiatives (heart failure and central line infection)
The resident works alongside the CEO, the Board Chair, attending physicians, nursing and other hospital departments in the above endeavors. They are exposed to hospital report cards and able to understand them as well as quality initiative annual reports and other parameters used to measure hospital safety and quality.
Results: Resident feedback has been encouraging. Participants report they have acquired the requisite tools to approach the practice of medicine cognizant of the patient safety issues and to partner with their institutions to continuously improve patients safety. Furthermore, our residents attain competency in System Based Practice and Patient Based Learning and Improvement.
A recent RRC review of our internal medicine program included a RRC commendation for meeting the optional requirement that "all residents receive formal instruction regarding the principles, objectives, and processes of quality assessment and improvement and of risk management."
Hospital value measures reflect improved measures of patient care quality including an actual to expected mortality ratio of 0.6.
Discussion: The above sequence illustrates that patient safety can be taught, and that residency is an ideal time to instill a culture of patient safety in physician training. The effects of such an initiative are far reaching. We are confident that our residents will be welcome members of the healthcare leadership team at the hospitals in which they choose to practice. In our own institution, the residency program, the hospital facility and the patients cared for by the hospital all continue to benefit from this educational initiative.
Results: Resident feedback has been encouraging. Participants report they have acquired the requisite tools to approach the practice of medicine cognizant of the patient safety issues and to partner with their institutions to continuously improve patients safety. Furthermore, our residents attain competency in System Based Practice and Patient Based Learning and Improvement.
A recent RRC review of our internal medicine program included a RRC commendation for meeting the optional requirement that "all residents receive formal instruction regarding the principles, objectives, and processes of quality assessment and improvement and of risk management."
Hospital value measures reflect improved measures of patient care quality including an actual to expected mortality ratio of 0.6.
Discussion: The above sequence illustrates that patient safety can be taught, and that residency is an ideal time to instill a culture of patient safety in physician training. The effects of such an initiative are far reaching. We are confident that our residents will be welcome members of the healthcare leadership team at the hospitals in which they choose to practice. In our own institution, the residency program, the hospital facility and the patients cared for by the hospital all continue to benefit from this educational initiative.
