AHME Institute 2014
CLE SYMPOSIUM –Part 2:
Focus on Patient Safety, Quality
Improvement and Transitions of Care
May 14, 2014
Charleston Marriott
Charleston South Carolina
Charles Daschbach, MD, MPH
St.Joseph’s Hospital and Medical Center
Phoenix,Arizona
St. Joseph’s Hospital & Medical Center
--626 licensed beds
--Barrow Neurological Institute
--Heart Lung Institute
--University of Arizona Cancer Center 2015
--225 residents 200 employed faculty
--9 residencies, 12 fellowships
--NIH basic science grants, full vivarium
--Catholic heritage
--Strong Housestaff Leadership Council
--IHI Chapter
St. Joseph’s Hospital & Medical Center
--head start…getting GME involved in QA / PS 2yrs
…why?
ACA…HCAHPS…VBP…CMS Core Measures
recognition of Housestaff IMPACT !
--used the “SAQ” survey w/ res & fac to validate
ACGME res and fac surveys
--Monthly Quality Report went to Housestaff
Leadership Council
--residents on quality and patient safety committees,
including the Board of Directors’ Quality Committee
CLER Report Analysis
--it’s NOT about the CLER Report !!!
--it’s NOT about the Clinical Learning Environment!!
--it’s about how the Clinical Learning Environment
interacts with PATIENT CARE AND PATIENT
EXPERIENCE
leading to BETTER patient care
(not about getting a “better” CLER Report or looking better
when national CLER data comes out this summer!)
CLE Campaign 3 Years
--CLER is a TOOL that helped catalyze our previous
efforts…
--nothing gets PDs attention more than the ACGME…
--especially after being exhausted laboring over
Milestones ad infinitum (to infinity and beyond!)
CLER Approach
--Education
--Engagement
--Evaluation
--Enculturation
(AHME Webinar August)
IHI Quality & Patient Safety Core Modules
IHI started in 1991 by Dr. Don Berwick, true visionary leader
Cambridge MA …independent not-for-profit…GOLD STANDARD
Goal is nothing short of improving the health of everyone on the earth
Seminars, workshops, WORK GROUPS, …national mtg in Dec …
Web site…emails…WIHI Radio Broadcasts 100 EEs, 100s faculty
Open School with 660 chapters in 70 countries
Open School WEB COURSES (Certificate if complete 13 CORE)
9 Patient Safety
8 improvement Capability (Quality)
1 Quality Cost and Value
3 Person and Family-Centered Care
1 Triple Aim
1 Leadership
$300 Prof Sub, volume discounts (51-100 $5400),
FREE for Open School Students / Faculty
TOO MANY LINES ON ONE SLIDE? TOO BAD !!!
AMA Introduction to Practice of Medicine
AMA experts, National Experts and Ohio State Faculty developed
35 Modules Based on the ACGME Core Competencies
Lecture and interactive formats …some short some long
Post Assessments and Course Certificate
…Programs can select which modules for them at each PGY level
…GME Office and PD can track
…being adapted updated for CLER Pathways
RESIDENTS LIKE ADDITIONAL TOPICS :
Intro Personal Finance
Resident as Teacher
Medicare / Medicaid 101
Anatomy of Litigation
Cost volume based …$40 / yr for 200 residents
Great personal support from IPM staff
Advanced Practice Solutions
“Resident Supervision”
Risk Reduction company out of Boston
Educational emphasis is a Team Approach to Risk
CEO Russ Richmond MD
Modules
13 Core Risk (incl. Res Supervision)
12 Ob/Gyn
6 Surgery
3 Internal Medicine
5 Patient Safety
https://www.aps-web.com/
Can get a DEMO account for no charge
Have volume discounts
CLE Campaign--REQUIP
--REQUIP…Resident Quality Incentive Program
took the Bobby Baron UCSF model to incentivize
residents 2014—2015 …
6 CMS Core measures …$1500 / resident if we hit all
6 targets
cost $300K…but what is cost if we do NOT hit
measures
CLE Campaign—REQUIP
Engaging ALL RESIDENTS !!!
CLE Campaign—”Layering In”
--Academic Excellence Day…added prizes for Quality
and Pt. Safety
--Asked ALL Journal Clubs to include Q/PS
articles…and consider Q/PS aspects of general
clinical articles
--Asked M&M Conferences to include Q/PS in case
reviews
--QIO at GMEC to review ONE Quality Measure w/
our data (no > 10 min, unless members want to
comment)
CLE Campaign—Patient Experience
--Posters
--Essay Contest “Humankindness”
--Cleveland Clinic “Empathy” video
(hospital has RESOURCES to HELP with this!)
CLE Campaign—Patient Experience
CLE Campaign—Patient Safety
“WTF”
Some last thoughts…
1. Big or Small, need a comprehensive approach to CLE
2. It will take a concerted effort with Hospital and Clinic
Committees, Nursing, Pharmacy, Quality, Risk
Management, Care Transitions, Human Resources, and IT
3. Steering Group?
GMEC or sub-committee
Housestaff Leadership
Join current efforts (w/o stepping on toes)
Special group of positive conspirators
AHME Institute 2014
CLE SYMPOSIUM –Part 2:
Focus on Patient Safety, Quality
Improvement and Transitions of Care
May 14, 2014
Charleston Marriott
Charleston South Carolina
Charles Daschbach, MD, MPH
St. Joseph’s Hospital and Medical Center
Phoenix, Arizona