Joanne Conroy, MD

Quality and Safety in Resident Training

A current national debate rages over how we can integrate quality and safety in training that aligns with institutional quality and safety priorities. That makes a lot of sense, as it should prevent resident quality efforts from being one-offs. It also leverages the residents’ frontline role to identify quality issues and find solutions that will benefit everyone.

That sounds great, doesn’t it? There could be real cost savings if we do this right—if we eliminate unnecessary effort on “check-the-box” activities that don’t improve care measurably. We can improve value to patients and consumers of care by decreasing HACs and focusing on transitions in care.

However, there are some significant obstacles:

Residents don’t report. Why not? It takes too much time; there’s a fear of retribution; there’s no follow up.
We don’t really know, as institutions, how to prioritize reports about quality issues. Not all are high-risk and high-impact.
There are not enough shared metrics between academic programs and teaching hospitals. Do residents know what a core measure is? Does the hospital know anything about the expectations for resident training in quality and safety?
People suffer from information overload. How do we put quality and safety standards and outcomes in front of faculty and residents every day?
The quality and safety competency of our faculties is inconsistent. Faculty are looked to as content experts and role models.
We lack rewards. Institutions have seen lots of success with resident incentive programs, but it is more than accolades that drives programs. It’s not only what you reward—it’s what you allow. Where are quality and safety on your list of institutional priorities? Probably after market growth and financial health.
So what do we do?

Focus on training faculty as well as residents. There are plenty of train-the-trainer programs and online educational opportunities. Find a way to measure success in faculty transformation.
Create the business case. It is there.
Think about reporting relationships. Shouldn’t your institutional quality and safety leaders be embedded in every GME discussion, and vice versa?
Reward faculty and resident efforts…through promotion and tenure, incentives, acclaim. Harvard has an Education Innovation faculty promotion track.
Connect the dots all the way to your board.
Close the gap between policy and practice in your institution. Use the Best Practices for Better Care Front Line Check-In Survey, the UHC Quality Assessment, the AHRQ Culture of Safety Survey, or your state’s Hospital Association Quality initiative. The Alliance of Independent Academic Medical Centers has a coordinated national initiative. Any of these can help you identify areas that need work.
What are you doing in your institution to align quality and safety in resident training with institutional priorities? How do you encourage communication and a feedback loop between your academic program and your hospital? What has worked—and not worked—for you?

Originally posted on

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