Resources for Quality Improvement, Patient Safety, and Cost Containment

Rationale

One of the key components of the Accreditation Council for Graduate Medical Education (ACGME) Next Accreditation System is an enhanced resident education in patient safety, quality improvement, and cost containment under the rubric of Systems-Based Practice (SBP).

Specifically, the ACGME requires "one example and the outcome of a planned quality improvement activity or project in which at least one resident participated in the past year that required the resident to demonstrate and ability to analyze, improve and change practice or patient care. Describe planning, implementation, evaluation and provisions of faculty support and supervision that guided this process".

Regarding patient safety, the ACGME requires a "description of a learning activity that demonstrates how the program supports the development of resident skills for identifying system errors. Important elements may include identified faculty to guide the activity, mechanism to ensure active engagement by each resident, and evidence of experiential learning (not just passive presence at conferences or meetings) in which residents participate in identifying a system problem or error and contribute to a potential solution. Additional documentation would be the written goals and objectives for this learning activity and how residents are assessed. Aggregated resident outcomes may be in the form of percentage of residents that completed a patient safety or other SBP project by the end of training, annual list of improvements that resulted from such projects, etc. Site visitors may verify responses through interviews as needed".

Finally, the application of considerations of cost containment and risk-benefit analysis falls within the rubric of SBP. Residency programs are required to document engagement through "written goals and objectives for the learning activity, curriculum (didactic and experiential) that demonstrates the elements of SBP, and assessment of resident outcomes among the required learning activities that qualify as SBP…".

Recognizing the challenge of incorporating these increasingly relevant concepts into traditional residency training curriculum, this website is intended to provide teachers, learners and program leaders with a single source for specific, concrete resources to facilitate formal engagement with quality improvement, patient safety, and cost containment projects.

Resources

The AHRQ QI Toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ and use them to successfully improve quality and patient safety in your hospital. The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 18 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs). The QI Toolkit supports hospitals that want to improve performance on the IQIs and PSIs by guiding them through the process, from the first stage of self-assessment to the final stage of ongoing monitoring. The tools are practical, easy to use, and designed to meet a variety of needs, including those of senior leaders, quality staff, and multistakeholder improvement teams. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge.
The TeamSTEPPS® is an evidence-based teamwork system aimed at optimizing patient care by improving communication and teamwork skills among health care professionals, including frontline staff. It includes a comprehensive set of ready-to-use materials and a training curriculum to successfully integrate teamwork principles into a variety of settings.
ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in the private sector. ACS NSQIP has the tools, training, customization options and, most importantly, data, to keep your hospital ahead of the curve.

The Quality Training Program prepares teams of oncology providers to design, implement and lead successful quality improvement activities in their practice settings. ASCO’s program is developed by oncologists and oncology care specialists for oncology practice teams.

The 6-month program offers education and training for physician-led oncology teams, including:

  • Five days of in-person learning in a series of three sessions – including seminars, case examples and small group exercises.
  • A structured and facilitated improvement project – selected by each oncology team to solve a problem in their own clinical setting – with guidance from experienced coaches.
Teaching for Quality (Te4Q) is a faculty development program that trains clinical faculty how to effectively teach quality improvement and patient safety (QI/PS) to medical students, residents, and other clinicians. By training clinical faculty how to integrate QI/PS across the continuum of medical education, Te4Q ensures that QI/PS is a part of medical education from day one. Te4Q was created in response to an identified gap in the education of students, residents, and practicing clinicians in quality improvement and patient safety. Te4Q also supports multiple national academic and clinical priorities for improved patient and health care outcomes, with an emphasis on progressive accreditation requirements (e.g., those of the Accreditation Council for Graduate Medical Education).
CMS Links to Quality Initiative and Roadmaps for:
  • Quality Measurement in the Traditional Medicare Fee-for-Service Program
  • Resource Use Measurement in the Traditional Medicare Fee-for-Service Program
  • Implementing Value Based Purchasing in the Traditional Medicare Fee-for-Service Program
Online training modules on quality improvement, patient safety, medical errors.
The IHI Open School brings you essential training and tools in an online, educational community to help you and your team deliver excellent, safe care. When you engage with the Open School courses and Chapters, you join more than 250,000 learners from universities, organizations, and health systems around the world in building core skills in improvement, safety, and leadership.
The Armstrong Institute's online Patient Safety Certificate Program delivers core concepts and tools to be an effective patient safety champion in your hospital, clinical department or unit/clinic. The program's 13 modules, which can be taken anywhere and at any time, delve into core concepts in such areas as:
  • Fostering a culture of patient safety
  • Delivering patient-centered care
  • Designing safer care delivery systems
  • Enhancing interdisciplinary teamwork and communication
  • Sustaining change
  • Tools and strategies for identifying and mitigating hazards.

Patient safety initiatives, both in the United States and overseas, have used this online program to prepare key organizational safety leaders and build their organizations’ internal capacity for improvement.

A curriculum focused on disease and the management of disease is no longer adequate for the training of physicians and other healthcare providers who are expected to practice in an environment where medical errors, system shortcomings, and physician/practice scorecards are the norm. Quality improvement and patient safety are critical components of building new paradigms of professional practice in healthcare. With an understanding of the basic concepts and best practices in quality and safety, we hope that healthcare providers can significantly enhance the care they provide and, in turn, improve patient outcomes.

The Mayo Clinic Quality Academy curricular modules cover topics related to quality improvement, quality measurement, patient safety, evidence-based medicine, leadership, and health policy. Some of the content areas are covered through basic and advanced modules; in general, we would recommend that the basic modules are more relevant for an undergraduate/graduate health professions student, while the advanced modules are for those interested in further training in the area and for practicing health professionals.

With the generous support of the Josiah Macy Jr. Foundation, the Mayo Clinic Quality and Safety Curriculum Initiative, our team of Mayo Clinic experts is pleased to introduce nine curricular modules and faculty syllabi for eight validated objective structured clinical examination (OSCE) stations. We anticipate that these materials will be useful for a) practicing physicians, b) residents and fellows, c) medical students, and d) allied health students. For educators who wish to track progress in learning, we have included pre- and post-learning questions with each module.

The Health Resources and Services Administration (HRSA) recognizes the need for a toolkit of objective educational tools and resources to assist an organization in its quality improvement (QI) efforts. The HRSA Quality Toolkit is equipped with proven strategies and techniques to effectively support an organization's new or existing QI program. The toolkit's wide range of practical, convenient, and useful tools were contributed and compiled from several HRSA organizations, where members have proven their usefulness in current QI health care delivery initiatives. The tools and resources were used for implementing data collection and performance measurement techniques, and the organizations that integrated their use into QI programs effectively improved their deliveries of care. These resources are adaptable and may be used to facilitate the implementation of a new QI program or fine tune an existing one.
The AHRQ QI Toolkit is designed to help your hospital understand the Quality Indicators (QIs) from AHRQ and use them to successfully improve quality and patient safety in your hospital. The AHRQ QIs use hospital administrative data to assess the quality of care provided, identify areas of concern in need of further investigation, and monitor progress over time. This toolkit focuses on the 18 Patient Safety Indicators (PSIs) and the 28 Inpatient Quality Indicators (IQIs). The QI Toolkit supports hospitals that want to improve performance on the IQIs and PSIs by guiding them through the process, from the first stage of self-assessment to the final stage of ongoing monitoring. The tools are practical, easy to use, and designed to meet a variety of needs, including those of senior leaders, quality staff, and multistakeholder improvement teams. Created by the RAND Corporation and the University HealthSystem Consortium with funding from AHRQ, it is available for all hospitals to use free of charge.
The TeamSTEPPS® is an evidence-based teamwork system aimed at optimizing patient care by improving communication and teamwork skills among health care professionals, including frontline staff. It includes a comprehensive set of ready-to-use materials and a training curriculum to successfully integrate teamwork principles into a variety of settings.
ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in the private sector. ACS NSQIP has the tools, training, customization options and, most importantly, data, to keep your hospital ahead of the curve.
Teaching for Quality (Te4Q) is a faculty development program that trains clinical faculty how to effectively teach quality improvement and patient safety (QI/PS) to medical students, residents, and other clinicians. By training clinical faculty how to integrate QI/PS across the continuum of medical education, Te4Q ensures that QI/PS is a part of medical education from day one. Te4Q was created in response to an identified gap in the education of students, residents, and practicing clinicians in quality improvement and patient safety. Te4Q also supports multiple national academic and clinical priorities for improved patient and health care outcomes, with an emphasis on progressive accreditation requirements (e.g., those of the Accreditation Council for Graduate Medical Education).
Online training modules on quality improvement, patient safety, medical errors.
The IHI Open School brings you essential training and tools in an online, educational community to help you and your team deliver excellent, safe care. When you engage with the Open School courses and Chapters, you join more than 250,000 learners from universities, organizations, and health systems around the world in building core skills in improvement, safety, and leadership.
The Armstrong Institute's online Patient Safety Certificate Program delivers core concepts and tools to be an effective patient safety champion in your hospital, clinical department or unit/clinic. The program's 13 modules, which can be taken anywhere and at any time, delve into core concepts in such areas as:
  • Fostering a culture of patient safety
  • Delivering patient-centered care
  • Designing safer care delivery systems
  • Enhancing interdisciplinary teamwork and communication
  • Sustaining change
  • Tools and strategies for identifying and mitigating hazards.

Patient safety initiatives, both in the United States and overseas, have used this online program to prepare key organizational safety leaders and build their organizations’ internal capacity for improvement.

A curriculum focused on disease and the management of disease is no longer adequate for the training of physicians and other healthcare providers who are expected to practice in an environment where medical errors, system shortcomings, and physician/practice scorecards are the norm. Quality improvement and patient safety are critical components of building new paradigms of professional practice in healthcare. With an understanding of the basic concepts and best practices in quality and safety, we hope that healthcare providers can significantly enhance the care they provide and, in turn, improve patient outcomes.

The Mayo Clinic Quality Academy curricular modules cover topics related to quality improvement, quality measurement, patient safety, evidence-based medicine, leadership, and health policy. Some of the content areas are covered through basic and advanced modules; in general, we would recommend that the basic modules are more relevant for an undergraduate/graduate health professions student, while the advanced modules are for those interested in further training in the area and for practicing health professionals.

With the generous support of the Josiah Macy Jr. Foundation, the Mayo Clinic Quality and Safety Curriculum Initiative, our team of Mayo Clinic experts is pleased to introduce nine curricular modules and faculty syllabi for eight validated objective structured clinical examination (OSCE) stations. We anticipate that these materials will be useful for a) practicing physicians, b) residents and fellows, c) medical students, and d) allied health students. For educators who wish to track progress in learning, we have included pre- and post-learning questions with each module.

The ABIM Choosing Wisely toolkit is for employers to use to educate their employees about the dangers and issues associated with the overuse of health care services.

These materials can help you launch the Choosing Wisely campaign with our employees or integrate it with your current communication efforts, all with your own brand. These materials are intended for broad distribution. They’re written to “speak” to diverse workforces across a variety of industries.

The toolkit itself is organized into four pieces:

  1. Materials for employers to learn about Choosing Wisely, and how to use the toolkit;
  2. Materials for employers to use and distribute to their employees;
  3. A series of Consumer Reports tip sheets that organize Choosing Wisely into topics that will be easy for employees to identify with; and
  4. Links to a wide variety of Consumer Reports resources on health and health care.

The High Value Care Curriculum (HVC) has been jointly developed by the American College of Physicians (ACP) and the Alliance for Academic Internal Medicine (AAIM) in an effort to train physicians to be good stewards of limited healthcare resources. This curriculum was initially released in July of 2012 and is available in a condensed and updated format. The newer version of the curriculum can be completed in six hours and includes audio/video content and a robust program director toolbox to help program directors measure curricular impact and individual resident performance in high value care.

Six Curriculum Topics:

  1. Eliminating Healthcare Waste and Over-ordering of Tests
  2. Healthcare Costs and Payment Models
  3. Utilizing Biostatistics in Diagnosis, Screening and Prevention
  4. High Value Medication Prescribing
  5. Overcoming Barriers to High Value Care
  6. High Value Quality Improvement
ACS NSQIP is the leading nationally validated, risk-adjusted, outcomes-based program to measure and improve the quality of surgical care in the private sector. ACS NSQIP has the tools, training, customization options and, most importantly, data, to keep your hospital ahead of the curve.
CMS Links to Quality Initiative and Roadmaps for:
  • Quality Measurement in the Traditional Medicare Fee-for-Service Program
  • Resource Use Measurement in the Traditional Medicare Fee-for-Service Program
  • Implementing Value Based Purchasing in the Traditional Medicare Fee-for-Service Program
The Learning Network serves hundreds of educators and health systems directors and connects them to leaders in the field who share practical advice about how to develop engaging curriculum and health systems innovations.

Our goal is to openly discuss ways to get started, implement, and sustain feasible innovations at your institution or organization.

The IHI Open School brings you essential training and tools in an online, educational community to help you and your team deliver excellent, safe care. When you engage with the Open School courses and Chapters, you join more than 250,000 learners from universities, organizations, and health systems around the world in building core skills in improvement, safety, and leadership.
A joint project of Costs of Care and the ABIM Foundation, the Teaching Value in Health Care Learning Network is a dynamic community of medical residents, students, faculty and others who are committed to learning and teaching the principles of stewardship and high-value care. Here you will find resources to help—didactic modules, experiential techniques, systems-level strategies, and the wisdom and creativity of fellow trail-blazers seeking to re-shape clinical learning environments toward high-value patient care. Monthly Hangouts with guest leaders and innovators will spotlight successful tools and strategies that you can apply, and discussion boards can help you refine and fortify your own ideas. Join the movement.

Arif H. Kamal, Doris Quinn, Timothy D. Gilligan, Barbara Corning Davis, Carole K. Dalby, Jennifer Bretsch, Kristen K. McNiff, and Joseph O. Jacobson. Feasibility and Effectiveness of a Pilot Program to Facilitate Quality Improvement Learning in Oncology: Experience of the American Society of Clinical Oncology Quality Training Program. JOP. 2016 Feb;12(2):177

Boonyasai RT, Windish DM, Chakraborti C, Feldman LS, Rubin HR, Bass EB. Effectiveness of teaching quality improvement to clinicians: a systematic review. JAMA. 2007 Sep 5;298(9):1023-37.

Cooke M. Cost consciousness in patient care--what is medical education's responsibility? N Engl J Med. 2010 Apr 8;362(14):1253-5.

Gupta R, Arora VM. Merging the Health System and Education Silos to Better Educate Future Physicians. JAMA. 2015 Dec 8;314(22):2349-50.

Eve Glicksman. Teaching Doctors How to Improve Care and Lower Costs…at the Same Time. AAMC Reporter: June 2015. https://www.aamc.org/newsroom/reporter/june2015/434756/lower-costs.html

Joseph O. Jacobson, Doris Quinn, Timothy Gilligan, Barbara Corning Davis, Carole Dalby, Jennifer Bretsch, and Kristen McNiff. The ASCO Quality Training Program: Designing and Implementing a Medical Specialty Society–Based Quality Improvement Training Program. JOP. May 1, 2014:203-205

McMillan JA, Ziegelstein RC. Implementing a graduate medical education campaign to reduce or eliminate potentially wasteful tests or procedures. JAMA Intern Med. 2014 Oct;174(10):1693.

Moriates C, Dohan D, Spetz J, Sawaya GF. Defining competencies for education in health care value: recommendations from the University of California, San Francisco Center for Healthcare Value Training Initiative. Acad Med. 2015 Apr;90(4):421-4.

Moriates C, Mourad M, Novelero M, Wachter RM. Development of a hospital-based program focused on improving healthcare value. J Hosp Med. 2014 Oct;9(10):671-7

Moriates C, Shah N, Arora VM. Medical training and expensive care. Health Affairs. 2013 Jan;32(1):196

Moriates C, Shah N. Creating an effective campaign for change: strategies for teaching value.JAMA Intern Med. 2014 Oct;174(10):1693-5.

Mosser G, Frisch KK, Skarda PK, Gertner EA. Addressing the challenges in teaching quality improvement. J Med. 2009 May;122(5):487-91.

Neeman N, Sehgal NL, Davis RB, Aronson MD. Quality improvement and patient safety activities in academic departments of medicine. Am J Med. 2012 Aug;125(8):831-5.

Pingleton SK, Davis DA, Dickler RM. Characteristics of quality and patient safety curricula in major teaching hospitals.Am J Med Qual. 2010 Jul-Aug;25(4):305-11.

Stammen LA, Stalmeijer RE, Paternotte E, Oudkerk Pool A, Driessen EW, Scheele F, Stassen LP. Training Physicians to Provide High-Value, Cost-Conscious Care: A Systematic Review. JAMA. 2015 Dec 8;314(22):2384-400.

Weinberger SE. Providing high-value, cost-conscious care: a critical seventh general competency for physicians. Ann Intern Med. 2011 Sep 20;155(6):386-8.

Wong BM, Levinson W, Shojania KG. Quality improvement in medical education: current state and future directions. Med Educ. 2012 Jan;46(1):107-19.

Yvonne Steinert PhD, Karen Mann, Angel Centeno, Diana Dolmans, John Spencer, Mark Gelula & David Prideaux (2006) A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8, Medical Teacher, 28:6, 497-526

Enhanced recovery after surgery (ERAS) protocols promote standardized perioperative care, which ultimately improves the quality of care delivered, accelerates recovery and safety, and optimizes use of health care resources. This project, initiated by the departments of Surgical Oncology and Anesthesia for major pancreatic surgeries, has been expanded with the input of urology residents and faculty to include patients undergoing cystectomy, retroperitoneal lymph node dissection, and open nephrectomy. Data collection and outcome analysis is ongoing.

For more information, contact Matt Nielsen: mnielsen@med.unc.edu.