Lean Belt Certification

Abstract

Since July 2013, 20 trainee participants have completed the quality improvement curriculum within the Indiana University Department of Otolaryngology-Head & Neck Surgery, including 7 otolaryngology residents, 6 otolaryngology-bound medical students, and 7 psychiatry residents. Nine faculty and staff attended. Participants were highly satisfied with the quality and effectiveness of the program. Following program implementation, 2 otolaryngology residents and 2 medical students initiated their own quality improvement projects. Lean training directly resulted in oral and poster presentations at national conferences, journal publications, and institutional research and quality awards. Students completing the program established a local affiliate group of an international health care quality organization. Quality improvement training can be successfully incorporated into residency training with overwhelming program satisfaction and results in greater scholarly and professional development for motivated participants. The skillset acquired by participants leads to projects that improve patient care, increase value, and justify equipment and personnel retention and expansion.

Implementation and Evaluation of Quality Improvement Training in Surgery

“…The majority of studies (82%) were in general surgery, 11,28–40 plastic surgery, 9 otorhinolaryngology, 41 or of unclear specialty 42 . The majority of the studies (94%) were conducted in the United States 11,28–42 with a single study from the UK 9 . The study design was quasi-experimental in the majority of cases (76%), 11,28–30,32–35,38,39,41,42 1 is a retrospective case evaluation, 31 2 controlled or randomized pre-post 9,40 and 2 did not report the study design 36,37 …”

“…36,37 The total number of surgical participants was in excess of 350 across all studies-although there was no study size reported in 41% of studies. 9,29,[34][35][36]39,42 The reported QI training intervention was either a curriculum development with group discussion, 29 workshops, 38,37 QI collaboratives, 35,39 QI projects and didactics 9,28,41,42 or a combination of curriculum development with the aforementioned pedagogies, 11,32 QI skills training delivered through a bootcamp, 33 or multidisciplinary morbidity & mortality (M&M) conferences 31 as well as practice-based learning and improvement. 30,34,36,40 For the full list of the characteristics for each study, see Table 1.…”

“…Based on this approach, we identified that studies were reporting implementation efforts on creating a learning collaborative (29%), 32,33,37,39,42 conducting ongoing training (18%), 28,34,41 building a coalition (18%), 35,36,38 developing a formal implementation blueprint (12%), 11,30 developing and implementing tools for quality monitoring (12%), 9,29 making training dynamic (6%), 31 or capturing and sharing new knowledge (6%). 40 Only 1 study mentioned the need for external support and testing of requirements for scaling-up the intervention, although no specific metrics or plans were provided on this.…”

“…All but 2 studies 9,40 scored high on risk of being uncontrolled studies or without a comparative cohort, whereas all studies scored high on selective reporting except 5 studies 11,28,29,34,38 which were of unclear risk. Finally, 70% of studies scored high on bias on the statistical evidence supporting the effectiveness of the intervention, with only 2 studies scoring low 40,41 and 3 of unclear risk, 9,34,36 as shown in Figure 3B.…”

Teaching Quality Improvement and Patient Safety in Residency Education

“…For example, “Lean” is a process improvement methodology that originated in the manufacturing industry and was adapted for use in health care. The Department of OHNS at the Indiana University School of Medicine developed a pilot program facilitating a Lean Belt certification during a dedicated 3-month research block in postgraduate-year 3, resulting in significant academic productivity and achievement by several trainees of Yellow or Green Belt certification . Using the Lean framework, residents identify gaps in safety or quality and learn PS/QI while applying rigorous methodologies to correct problems.…”