Administration & Operations

Why You Should Participate in Quality Improvement

Given all the demands on time, quality improvement can seem obscure and prove challenging to incorporate into your training in a meaningful way. So, here are 5 reasons why you should participate in quality improvement during residency.

What is Quality Improvement?
Quality improvement is "systematic and continuous action that leads to measurable improvement in health care services and the health status of targeted patient groups."1 While it is not a novel concept in the health care industry, quality improvement is now becoming an integral component of medical education and training. In 1999 the U.S. Institute of Medicine released the landmark report "To Err is Human: Building a Safer Health System," which was followed up 2 years later with "Crossing the Quality Chasm: A New Health System for the 21st Century."2,3 These reports discussed the thousands of preventable medical errors that occur annually and proposed a framework for improvement. They are credited with creating awareness and have served as the foundation for work done today.4,5 Given all the demands on time, quality improvement can seem obscure and prove challenging to incorporate into your training in a meaningful way. So, here are 5 reasons why you should participate in quality improvement during residency.

1. Diversity of projects
When choosing a quality improvement project, you can focus on anything that interests you. Examples of projects we have seen through our own training or through the Quality Improvement and Patient Safety (QIPS) section of ACEP include improving sepsis metric compliance, ordering of second dose antibiotics (for boarding patients), point of care ultrasound labeling, pain control in the waiting room, improving patient satisfaction, and addressing second victim syndrome. You can identify and prioritize any area of improvement and use established quality improvement models to guide your work. Here are a few examples of quality improvement models:

  • Plan-Do-Study-Act (PDSA) cycles to model improvement with small tests of change.1
  • Six Sigma to eliminate defects and minimize variability.1
  • Lean Methodology to eliminate waste.1

In short, the breadth of topics is amazingly broad and dynamic. So, identify your interest, become a content expert, and work to make things better!

2. Publishing Opportunities
Time and effort put into quality improvement work should be recognized, celebrated, and shared. Sharing your success, and even your failure, may benefit not only patients but the healthcare sector as a whole. There are multiple publication platforms available for disseminating your work; but if writing a manuscript seems daunting to you, don't worry! You can present quality improvement projects as posters or oral presentations at your institution, or at regional and national conferences like ACEP and SAEM. While you are writing up your project, keep in mind that the QIPS section is always looking to highlight projects and circulate practical information to readers and they would love to highlight your projects! Find them at https://www.acep.org/how-we-serve/sections/quality-improvement--patient-safety/.

3. Great Addition to Your CV
Regardless of your practice setting after residency, there will be operational inefficiencies and patient care concerns that require action. Therefore, employers are continuously looking for champions of change. Going through the quality improvement process during residency will help you acquire skills that you can lean on during your career in emergency medicine. Presenting a quality poster, oral presentation or written publication is an excellent addition to your Curriculum Vitae. It demonstrates your understanding of the process, while simultaneously reflecting your innovation and personal interest. This will help you stand out when it comes time to explore job opportunities.

4. Improves Patient and System Outcomes
Quality improvement work often leads to meaningful change in clinical practice, or at least identifies core issues not otherwise well studied. There was a time when stroke, myocardial infarction and trauma care was heavily fragmented. Through scientific study and quality improvement work, such diagnoses have been better integrated into highly reliable systems.6-8 Another example, from the University of Pennsylvania, was the changing of default prescriptions from brand names to generics whenever appropriate. The result was tens of millions of dollars in savings for patients.9 Ideas like this may seem simple, but can lead to a substantial reduction in health care disparities and improvement in patient outcomes! 

5. Expectation of the ACGME
The ACGME expects resident participation in scholarship activities, one of which is quality improvement. Their guiding philosophy is "all physicians share responsibility for promoting patient safety and enhancing quality of patient care…Graduating residents will apply these skills to critique their future unsupervised practice and effect quality improvement measures."10 Even though involvement in scholarly work like quality improvement is a requisite during residency training, it can still be interesting and individualized. 

So, now that you know a little bit more about quality improvement, we hope you think about getting involved. Reach out to your department leadership and see what opportunities are out there. Remember, quality improvement is a broad term, so there is sure to be a project that aligns with your interests, and there is always a need for more resident involvement!


References

  1. Quality improvement. US Department of Health and Human Services Health Resources and Services Administration. https://www.hrsa.gov/sites/default/files/quality/toolbox/508pdfs/qualityimprovement.pdf. Published April 2011. Accessed February 11, 2020.
  2. Kohn LT, Corrigan JM, Donaldson MS, editors. Institute of Medicine Committee on Quality of Health Care in America. To err is human: building a safer health system. Washington (DC): National Academies Press (US); 2000.
  3. Institute of Medicine (US) Committee on Quality of Health Care in America. Crossing the quality chasm: a new health system for the 21st century. Washington (DC): National Academies Press (US); 2001.
  4. Dentzer S. Still crossing the quality chasm—or suspended over it? Health Aff (Millwood). 2011;30(4):554–555. 
  5. McKinney M. About that quality chasm. Modern Healthcare. February 21, 2011. Available at: https://www.modernhealthcare.com/article/20110221/MAGAZINE/110219950/about-that-quality-chasm. Accessed January 24, 2020.
  6. Edwards JM, Carr BG. Improving patient outcomes from acute cardiovascular events through regionalized systems of care. Hosp Pract. (1995). 2010;38(4):54–62.
  7. American College of Surgeons, Committee on Trauma. Resources for optimal care of the injured patient. Chicago: ACS;2006.
  8. Alberts MJ, Hademenos G, Latchaw RE, et al. Recommendations for the establishment of primary stroke centers. Brain Attack Coalition. 2000;283(23):3102–3109.
  9. Using default options to increase generic medication prescribing rates. Penn Medicine: The Nudge Unit. Available at: https://nudgeunit.upenn.edu/projects/using-default-options-increase-generic-medication-prescribing-rates. Accessed January 24, 2020.
  10. Accreditation Council for Graduate Medical Education. Common Program Requirements: Residency. Accreditation Council for Graduate Medical Education. Available at: https://www.acgme.org/Portals/0/PFAssets/ProgramRequirements/CPRResidency2019.pdf. Published June 10, 2018. Accessed January 6, 2020.

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