In an era where a majority of the pediatric hospital workforce is just starting to recognize fish bone diagrams, five why questions, root cause analysis, IHI, Lean, six sigma and pareto charts, hospitalists can be daunted as they try to serve as the home for quality improvement and patient safety in hospitals. Hospitalists are expected to know, understand, and practice these models for improvement with limited training and expertise. Beyond being looked at as experts, they are expected to teach residents and other learners when they are unsure of it ourselves. Governing education bodies (i.e., ACGME and CLER) have made it a requirement that residents have these concepts integrated into their curriculums and tracked.
Presented by an inter-professional team from Floating Hospital for Children at Tufts Medical Center in Boston, this PHM15 workshop focused on how to work in multidisciplinary teams to identify, analyze, and create patient-safety solutions, and, therefore, set the stage for systems- or department-based QI projects.
“It is OK to make mistakes, but it is not OK to not learn from them,” stated the presenters.
Starting with a near-miss event that led to a department/resident-led root cause analysis, the importance of system improvement became apparent. Presenters discussed the 12-week curriculum they created for pediatric residents and nursing students, which includes:
- Online, self-directed learning, and
- An inter-professional, small-group project.
Trainees present their analysis and action items to their departments and, at times, even administration. This helps align hospital goals with resident teaching, while simultaneously providing an environment where discussing errors safely in order to prevent further harms.
Attendees of the workshop walked away with a generalizable, step-by-step toolkit to take home to their home institution.
- Convene a leadership team of nurses and physicians to develop the inter-professional program
- Consider scheduling demands of nurses, physicians and residents.
- Implement administrative support to assist with scheduling of meetings, maintenance of documents and email distribution.
- Program participation must bring value to the staff such as CME credits
- Make the educational experience program flexible in a blended learning environment.
- Recognize staff’s completion of the program with a certificate.
- Provide the opportunity, mentorship and support for staff willing to continue the project as a quality improvement initiative. TH
Dr. Hopkins is a pediatric hospitalist at All Children's Hospital Johns Hopkins Medicine, and an instructor at Johns Hopkins Medicine in St. Petersburg, Fla.