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Sandra L Wong MD MS Department of Surgery University of Michigan

Educating for quality: Leveraging national and local partnerships for improving value and educating for quality. Development of Team Action Projects in Surgery (TAPS): a multi-level team-based approach to quality improvement. Sandra L Wong MD MS Department of Surgery University of Michigan.

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Sandra L Wong MD MS Department of Surgery University of Michigan

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  1. Educating for quality: Leveraging national and local partnerships for improving value and educating for quality Development of Team Action Projects in Surgery (TAPS): a multi-level team-based approach to quality improvement Sandra L Wong MD MS Department of Surgery University of Michigan

  2. Burning platform for change

  3. Bringing stakeholders together to address problems and continuously improve the quality of patient care Transformed Organization Individuals

  4. Opportunities within the Department of Surgery • Quality improvement (QI) • Gaps in care • Opportunities in training for QI • Stakeholder engagement • Shared goals in QI • Connecting and collaborating with colleagues • Professional development • Opportunities for leadership/mentorship development • Multi-level team building

  5. Collaboration with other colleagues Team Action Projects in Surgery(TAPS) Faculty lead– content expertise, resources Resident or resident teams– identification of a QI area, framing the project, didactic and action-based learning about QI Student teams– research experience, data collection/analysis

  6. TAPS: A win-win-win • Leadership development, clinical quality improvement (“training the trainer”) • Leadership development, fulfills upcoming GME core competency requirements • Research opportunity, investment in the academic pipeline

  7. Program elements • Key faculty elements • Residency program requirements • QI training • Doing the work of quality improvement • Feeding the academic pipeline • Faculty development • Key trainee elements • QI training • Doing the work of quality improvement • Leadership development

  8. TAPS Implementation • Faculty mentors • “Training the trainers” • Didactic/core curriculum • Learning the basic tenets of quality and safety • Leveraging health services research expertise • Lean Training • Managing to Learn curriculum • A3 structured problem solving process • Coaching available for current state mapping, value stream mapping, catchball, etc.

  9. TAPS Implementation • Team projects (practicum) for residents during their academic development time • Setting up teams • Premeds, engineering undergrads, M1-M2s, M4s • Interprofessional collaboration

  10. Making it work • Specific to an academic general surgery program • Didactic curriculum in PGY 1-3 years • TAPS “practicum” during dedicated academic development time  resident-driven QI project • Generalizability • Scale projects based on time availability • Look for opportunities within training programs

  11. TAPS– Terry Shih’s project Identified problem: Very high rates of C. Difficile infection and variation in treatment patterns • Infectious diseases, Epidemiology A3: Wide variation in processes of care between units/among providers; Weak knowledge base, poor implementation of hospital guidelines Gemba: Examine variation by services, unit; Collect data regarding current practices and current knowledge base

  12. TAPS– Bryner & Krell’s project • Emergency Department physicians • Hospitalists Identified problem: Process for adult general surgery consults is inefficient and can lead to errors/delays in care

  13. TAPS– Seth Waits’ Project Improving Length of Stay Following Donor Nephrectomy

  14. What does QI mean to a resident?

  15. Developing the Idea • Boots on the ground - Personal Stake • Must be achievable/timely • Capitalize on individual interest

  16. Drafting the Team

  17. Process Design

  18. Project Planning and Conception

  19. Data Collection “Gemba”

  20. “Gemba”

  21. Feasibility and Testing

  22. Implementation

  23. Funding • Opportunity to apply for funding and improve grant writing skills • Paid for expenses of 6 students for the summer with funding from an internal grant • Transforming Learning for a Third Century

  24. Lessons Learned • Leadership and innovation can come from any maturity of learner • Personal Stake Leads to Motivation • Everyone feels promoted • Resident  Young Faculty • Medical Student  Resident • Undergraduate  Medical Student

  25. “In the beginner’s mind there are many possibilities, in the experts mind there are few” -Shunryu Suzuki

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