How Successful Are Residents and Fellows at Quality Improvement?

Abstract

Background: Nationally, there is an expectation that residents and fellows participate in quality improvement (QI), preferably interprofessionally. Hospitals and educators invest time and resources in projects, but little is known about success rates or what fosters success. Purpose: To understand what proportion of trainee QI projects were successful and whether there were predictors of success. Methods: We examined resident and fellow QI projects in an integrated healthcare system that supports diverse training programs in multiple hospitals over 2 years. All projects were reviewed to determine whether they represented actual QI. Projects determined as QI were considered completed or successful based on QI project sponsor self-report. Multiple characteristics were compared between successful and unsuccessful projects. Results: Trainees submitted 258 proposals, of which 106 (41.1%) represented actual QI. Non-QI projects predominantly represented needs assessments or retrospective data analyses. Seventy-six percent (81/106) of study sponsors completed surveys about their projects. Less than 25% of projects (59/258) represented actual QI and were successful. Project category was predictive of success, specifically those aimed at preventive care or education. Conclusion: Less than a quarter of trainee QI projects represent successful QI. Implications: Hospitals and training programs should identify interventions to improve trainee QI experience.

The Evaluation of an Interprofessional QI Program: A Qualitative Study

“…This high motivation could also have been a pitfall when participants started QI projects that were too ambitious. Therefore, it is important to start with realistic and manageable QI projects and to set clear expectations with the participants [ 46 , 47 ]. The participants were most enthusiast about the seminars, which shows the importance of inspirational leaders in this program [ 43 ].…”

Improving inpatient hyperglycaemia in non-critically ill adults in resident wards through audit and feedback

“…Despite these ACGME requirements and benefits, there is limited literature describing interprofessional QI projects with residents and even less literature where residents take a leadership role in an interprofessional team 17–20. Furthermore regarding diabetes, there are published reports describing resident QI projects for diabetes management, yet they are solely in the outpatient setting 21–23…”

“…16 Despite these ACGME requirements and benefits, there is limited literature describing interprofessional QI projects with residents and even less literature where residents take a leadership role in an interprofessional team. [17][18][19][20] Furthermore regarding diabetes, there are published reports describing resident QI projects for diabetes management, yet they are solely in the outpatient setting. [21][22][23] A call to action from the American Diabetes Association states studies are needed to promote inpatient scheduled insulin, educate providers and change prescribing behaviour.…”