Improving Resident Engagement in Quality Improvement and Patient Safety Initiatives at the Bedside

Abstract

Quality improvement (QI) and patient safety (PS) are essential competencies in residency training; however, the most effective means to engage physicians remains unclear. The authors surveyed all medicine and surgery physicians at their institution to describe QI/PS practices and concurrently implemented the Advocate for Clinical Education (ACE) program to determine if a physician-centered program in the context of educational structures and at the point of care improved performance. The ACE rounded with medicine and surgery teams and provided individual and team-level education and feedback targeting 4 domains: professionalism, infection control, interpreter use, and pain assessment. In a pilot, the ACE observed 2862 physician-patient interactions and 178 physicians. Self-reported compliance often was greater than the behaviors observed. Following ACE implementation, observed professionalism behaviors trended toward improvement; infection control also improved. Physicians were highly satisfied with the program. The ACE initiative is one coaching/feedback model for engaging residents in QI/PS that may warrant further study.

Rethinking high reliability in healthcare: The role of error management theory towards advancing high reliability organizing

“…This form of coaching has been effective at achieving adherence with best practices, 39 professionalism, and infection control. 40 EMT coaching provides feedback the individual who committed the violation and provides feedback back to the organization about conditions and mitigating circumstances. Consider a hand hygiene compliance audit as an illustration.…”

“…This form of coaching has been effective at achieving adherence with best practices, 39 professionalism, and infection control. 40…”

Safety Coaches

“…Patient safety should be as central to medicine as the diagnosis and treatment of disease. The recent article by Schleyer et al 1 assessed the use of an Advocate for Clinical Education (ACE) in teaching patient safety (PS) and quality initiatives. The authors found that this coach/feedback model for teaching PS and quality improvement (QI) demonstrated an improvement in professionalism and infection control.…”

Residents' Perspectives on Patient Safety in University and Community Teaching Hospitals

“…In response, ensuring the safety of patient care became an important objective for resident education, with links to all 6 Accreditation Council for Graduate Medical Education (ACGME) compencies. [2][3][4][5][6][7] There have been efforts to assess the safety of patient care within and across disciplines. 3,8,9 When surveys have been conducted to seek their perspective on the safety of care in teaching settings, residents have reported multiple errors and threats to patient safety, including a lack of procedural training, inadequate sign-outs, teamwork problems, supervision issues, technology interface glitches, and long work hours.…”