Quality Improvement (QI)
PSQI Curriculum in the BCRP
The BCRP introduced a longitudinal PSQI curriculum in 2013 that aims to incorporate patient safety and quality awareness into each clinical rotation and year of your training to elevate resident involvement in hospital-level PSQI activities while appropriately balancing and complementing your clinical obligations.
WHY ARE WE DOING THIS: Patient safety and quality improvement have become a universal focus in healthcare delivery; therefore, BCRP graduates will not only be tasked with understanding and developing PSQI efforts within every practice setting, there will also be greater opportunities for PSQI leadership roles and career pathways. We want you to become facile with PSQI terminology and the basic skills needed to promote PSQI across patient care settings. We will support and encourage any resident with an interest in gaining greater experience and training in PSQI to build on these foundational skills with more robust and dedicated experiential training in the field.
WHAT’S ALREADY HAPPENING:
QI Simulation during Keystone. Each intern participates in a small group simulation that leads them through generation and maintenance of a QI initiative in response to a real patient quality problem. It challenges interns to think critically about socially-determined, structural, and systems-based barriers to providing safe, effective, patient-centered, efficient, equitable, and timely care. Working together, interns gather data and pitch novel ideas to hospital and residency QI experts to solve the proposed problem.
Experiential focus on rotation-specific and primary care clinic ongoing PSQI projects. These will include projects that many of your colleagues are already working on!
Morbidity and Mortality (M&M) noon conferences and Grand Rounds and a regular review of SERS/RL reports at BCH and BMC as a forum to discuss common errors, near-misses and system-wide issues that impact the delivery of quality patient care by residents.
Resident membership in the BCH and BMC Housestaff Councils on Patient Safety and Quality Improvement, which seek to identify and address systems issues and provide a forum for discussion of PSQI. You will hear about this council at the beginning of each academic year!
PSQI Activity Requirement
MUST BE COMPLETED BY MID-APRIL OF THE YEAR OF YOUR BCRP GRADUATION
***IMPORTANT: Genetics, Med-Peds, Neuro, and NDD residents need NOT complete this requirement through the BCRP. Instead, your QI activities are tracked through your non-BCRP residency programs***
This activity can be completed individually, as a pair, or in a group, and can address personal clinical improvement or more global processes. We want to stress that this may be simple and done in an afternoon, but may also be longitudinal and complex - the basis for your career in quality improvement! We strongly encourage you to speak with the BCRP QI chief resident and Marcella Luercio (BCH) to avoid investing time and energy into an activity that will not fulfill your requirement. We are here to help you and ensure that this is a fun and meaningful activity!
LOGISTICS
You will get an individual email from RedCap with a personalized link to the BCRP QI Activity Log for Graduation. This is how you will document your independent activity, so save this email!
You can view the minimum requirements for documentation prior to graduation based on your activity type by reading through a PDF version of the RedCap form HERE.
All activities except Housestaff QI council participation and PSQI elective completion require uploading two forms from IHI that ensure you have become comfortable with core QI concepts and tools:
What are the options?
Complete a 2+ week Patient Safety and Quality Improvement (PSQI) elective at BMC, BCH, or another institution.
Email Marcella Luercio to discuss options. For example, at BMC, the PSQI elective allows you to shadow the Chief Quality Office at institution-wide meetings and discussions while protecting time for self-study re: QI. This obviously takes some pre-planning to ensure you are anticipating all subspecialty graduation requirements, as well.
Be an active member of the BMC or BCH Housestaff Quality Council.
Spend time reviewing SERS/STARS and presenting that information to the residency while taking a seat at the table to add resident voices and insight into institutional QI priorities. Sound exciting? It is! More information on applying to these awesome councils is sent out at the beginning of each academic year. If you are interested off-cycle, email Marcella Luercio or a QI Chief.
You must attend at least 3 meetings or group presentations to meet your graduation requirement.
Participate in an ongoing PSQI project within a department while on rotation or within your clinic. Resident involvement in a project may be passed on to other residents.
To get credit for involvement in an existing project, you must demonstrate your direct involvement in planning at least 1 complete PDSA cycle of improvement and plan for the next cycle of change. One full cycle includes planning and developing an intervention, implementing the intervention, and measuring the impact of the intervention with planning for the next cycle. Even if you are unable to participate in the entire project within the duration of your residency, you must be able to demonstrate that you were actively involved in the process and articulate your thought process using the QI tools noted above.
Actively participate and present at the Department-wide M&M conference at either BMC or BCH.
For an M&M presentation to fulfill your PSQI requirement for BCRP, the presentation must go beyond a simple case presentation of what happened. You should undertake your own “root cause analysis” (it can be a very simple one) to identify where the holes in the Swiss cheese aligned to lead to the outcome. You must also consider and discuss what potential solutions could be implemented to prevent the outcome in the future. Some solutions may be high impact but have limited feasibility, whereas others are easier to implement quickly. You will also be required to complete a Driver Diagram and Project Proposal form related to the root cause you identified for this presentation.
This requirement may not be fulfilled with a PICU, NICU, or other rotation-specific M&M conference and instead must be department or division-wide (i.e. presentation at BCH or BMC Grand Rounds).
Identify a novel PSQI problem, design an intervention to address the problem, and assess the success of your intervention.
These can be focused on your individual practice as a physician (I.e. how can I improve my time to note completion in clinic?), an improvement in our educational curriculum, or an improvement in a larger hospital-wide workflow process (e.g. How can we decrease interruptions during sign-out?).
In order to qualify as a PSQI project, you must not only implement an intervention, but also assess whether that intervention was successful (did the intervention improve on its primary aim?) At minimum, your project should include at least 1 complete PDSA cycle of improvement with a plan for the next cycle of change.
One full cycle includes planning and developing an intervention, implementing the intervention, and measuring the impact of the intervention with planning for the next cycle. You can also involve multiple residents simultaneously or in tandem, and all can get credit for the same project!
Personal Primary Care patient panel improvement project
Sample your primary care patient charts (minimum n=20) to to see if you are accomplishing an important metric in the care of those patients (i.e. how many patients with asthma have AAPs? How many times did I screen for food insecurity and successfully refer to the food pantry? How many times did my 4mos patients get iron rx?)
From this baseline data, generate an idea for self-improvement: how can you get better at this specific goal? Set a goal, and utilize the Driver Diagram and Project Planning form to propose a set of interventions to improve.
Measure the next 20 patients - did you improve?
QI Blitz Journal Club Noon Conference and Email Digest
Our hope is that this opportunity will help the resident to walk through the QI steps articulated in recent QI publications to engage with and critically appraise a real-world QI/Patient Safety approach.
Choose a new or sentinel article related to Patient Safety/Quality Improvement and distill it into a brief synopsis. Pay attention to the specific problem the authors are trying to address through QI methods, the key aims and measures, interventions, and iterative PDSA cycles of improvement. The synopsis should also identify balancing measures with identification of other measures that should have been considered.
The blitz can be selected from journals focused on clinical areas of interest (Cardiology/GI, etc), or other journals focused on general pediatrics (Pediatrics) or medical education (Journal of Graduate Medical Education). Many of these journals will have at least one QI focused article per issue! Choose an article that interests you!
To meet this requirement, you must (1) schedule a journal club noon conference session through the BCH or BMC chiefs to present your findings (NOTE: these will be limited and first-come, first-served, email early!) and (2) generate an email digest that will be disseminated to the residency as a whole as a part of the QI Blitz email series. This should be emailed to Marcella Luercio for review prior to dissemination.
Examples of successful QI Blitz email digests HERE.
IHI Module Activity Requirement
MUST BE COMPLETED BY END OF KEYSTONE OR LAST DAY OF INTERN YEAR, WHICHEVER IS EARLIER
These modules review the basics of quality improvement theory and methodology. They are critical for understanding the universal QI approach to systems issues related to patient safety and quality. They are also a requirement of the BCRP, BCH, and BMC.
LOGISTICS
You should have already registered yourself with IHI during intern orientation using your personal or @childrens.harvard.edu email address and Boston Children’s Hospital as your institution. Hooray!
Now, complete 4 additional IHI modules that you have not yet completed (PS 102 and 103 and QI 102 and 103) by going to this LINK and enrolling in each module.
Log in, then click “Go to Your Learning Center.” Search for each of the following courses and click Enroll to begin the content.
PS 102: From Error to Harm
QI 102: How to Improve with the Model for Improvement
PS 103: Human Factors and Safety
QI 103: Testing and Measuring Changes with PDSA Cycles Log in, then click “Go to Your Learning Center.” Search for each of the following courses and click Enroll to begin the content.
Upload the 4 completion certificates so that we can confirm you have completed the modules.
To upload, log on to New Innovations -> My Profile -> My Personnel Record -> Checklists (top right hand corner). Scroll to the bottom, and there will a spot for all 4 modules to have PDFs uploaded!
If you don’t see them, email Monique at Monique.Bailey@bmc.org and cc’ed here. She will fix for you!