Quality improvement is a strategic objective that hinges on many victories at the front lines of medical care. The front lines are where medical residents work, and residents are well positioned to spot opportunities and lead meaningful quality improvements—if they know how.
A concise, resident-focused module from the AMA provides an actionable and broadly adaptable approach to remedy quality of care deficiencies.
The 21-minute module, “Quality Improvement Practices,” is of the AMA GME Competency Education Program offerings, which include more than 30 courses that residents can access online, on their own schedule.
Among the program’s experts are several who contributed to the AMA’s Health Systems Science textbook, which draws insights from faculty at medical schools that are part of the Association’s Accelerating Change in Medical Education Consortium.
Modules cover five of the six topics—patient care, practice-based learning and improvement, interpersonal and communication skills, professionalism, and system-based practice—within the Accreditation Council for Graduate Medical Education’s core competency requirements. The sixth requirement, medical knowledge, is one that is typically addressed during clinical education.
Quality improvement—such as making care better, faster or safer—applies to two tracks in clinical medicine in which residents are immersed. One is the range of patient care from diagnosis through treatment. The other, patient care systems, involves processes and procedures—for example, intake, handoffs, or working with the electronic medical record.
The module suggests that residents draw from their direct experience to identify triggers that indicate further investigation and action. It might be a nagging inefficiency or an incident as dramatic as a near-miss or an outright mistake.
Residents are also advised to consider looking closer to home: “A trigger could also be a personal tragedy, such as a close family member who died from a cancer that could have been cured if diagnosed earlier.”
The module presents the plan, do, study, act approach—PDSA for short—as the most straightforward combination of essential components to advance change and explains how the model is adaptable to a wide range of care and systemic challenges.
Put all the pieces together, during the plan stage, to start solving a problem. When confronting a situation requiring improvement, the module advises residents to “gather a team to help address it, define the problem as precisely as possible, choose an option for solving it, make a plan for data collection and decide how you will measure and know if the solution tested led to improvement.”
There’s an acronym—SMART—for setting the goals. They should be specific, measurable, action-oriented, realistic, and timely. Another module pointer is that an attending physician be part of the team to mentor and sponsor the initiative.
Try out the proposed solution in the “do” stage. At this point, collect fresh data for comparison to the baseline established in planning.
Analyze the solution’s impact in the study stage. Examine the results gathered in the do stage.
Implement the solution in the act stage. Adjustments, if needed, can be made on refinements indicated by data analysis from the study stage.
The PDSA cycle of improvement points to the broader message of the module, which is focused on the importance of attitude and outlook in quality improvement.
“The change you bring about doesn’t need to make the situation perfect; it just has to make it better or more efficient than it was before,” notes the module. “Quality improvement isn’t usually a one-step solution. It’s a continuous process of improvement. As you learn more, the solution you propose today could be added to or improved upon tomorrow.”