Children's Hospitals Today - Summer 2016 - 24

DELIVERY SYSTEM TRANSFORMATION QI TRAINING IN RESIDENCY OUTCOMES 600 Today's complex health care children impacted delivery system needs professionals each month knowledgeable in QI methods and techniques. Yet, according to Levine Children's Hospital, most of residents became medical students are graduating QI leaders since the with little to no exposure to QI. To program began help prepare the next generation of the workforce to lead in QI, Levine's Department of Pediatrics reviewed its approach to resident training. The organization launched changes to its program in 2009, and the class of 2012 became the first graduates of the updated residency program. The organization began working to improve QI knowledge while meeting the American College of Graduate Medical Education requirements for systems-based practice and practice-based learning. The hospital created a program that gives residents substantial responsibility as part of an interdisciplinary frontline care delivery team and uses improvement science to provide a standardized, evidence-based approach to improving care. While Levine created the program to fit its available resources and needs, it's easily adapted to individual locations. Through the use of hands-on projects, QI coaches and data analysts, program evaluation and individual coaching, the hospital saw an increase in resident confidence levels for QI knowledge and skills, and 100 percent of 2015 graduates had leadership roles in QI projects. Laura Noonan, M.D., director of the Center for Advancing Pediatric Excellence at Levine, says that the most rewarding parts of this program are the number of children that these 82% projects are impacting and the knowledge that residents are gaining in problem solving. "Instead of impacting one child's life at a time, these projects are involving hundreds of children's lives at a time and getting them the care they need," Noonan says. "It will be a while before we see significant outcomes change, but we are now improving care in a reliable, consistent manner." The most challenging part, Noonan says, was fitting more into an already full curriculum. "Their jobs change every month from working with healthy newborns to ill and dying patients," she says. "That pushes us to think creatively about learning and education, but it acts as a barrier." 7 changes for improvement Here are strategies Levine Children's Hospital tested in improving its resident training program. IHI modules assignments. This portion of the curriculum, which utilizes free online courses for professional continuing education created by the Institute for Healthcare Improvement (IHI) is reviewed annually for needed changes. Assigned readings. The hospital saw low compliance with assigned reading among residents and, after adjusting the amount of reading and its content, changed the name from "required" to "recommended" readings. Faculty QI mentors. The traditional resident/faculty mentorship was deemed ineffective, so the program moved to utilizing the QI coach and data analyst for all of the mentoring. Personal improvement projects (PIP). The first year, students gain experiential learning through a PIP, a hands-on introduction to QI, and a reflective practice project, a chart audit exercise where residents analyze their performance. Residents say this is one of the strongest elements in the program. Juan Pulido, Children's Health Children's Medical Center, Dallas Resident leadership role. The program began with a physician champion but that proved overwhelming. Now, the program allows residents to take ownership of a small piece of a larger project. Individualized coaching. QI coach and data analyst meetings encourage self evaluation during the program. Scenario testing. Residents are scored on implementing their QI knowledge in a realistic pediatric scenario, standardized by experts. This was adapted for pediatrics from the adult-based Quality Improvement Knowledge Application Tool (QIKAT). 24 CHILDREN'S HOSPITAL S TODAY Summer 2016 childrenshospital s.org http://www.childrenshospitals.org

Table of Contents for the Digital Edition of Children's Hospitals Today - Summer 2016