Systems Based Practice (SBP)

1. Systems Based Practice (SBP) Dempsey Springfield, MD Associate Director for Partners GME

2. Conflicts of Interest • Member of Orthopaedic Dept. at MGH • Associate Director for Partners GME • Deputy Editor for Journal of Bone and Joint Surgery • No financial interest in products related to Systems-based Practice.

3. Teach Evaluate Declare competent.

4. Competency Based Education • Competency-based education focuses on learner performance in reaching specific objectives. • Not could they have learned but did they learn.

5. Goals & Objectives • Goals are broad; objectives are narrow. • Goals are general intentions; objectives are precise. • Goals are intangible; objectives are tangible. • Goals are abstract; objectives are concrete. • Goals can't be validated as is; objectives can be validated.

6. Objective is to run 5-6 miles 4 days per week and sprints 2 days per week for the 6 months prior to the race. Feedback: You need to pick up your pace on long runs. Your sprint days are perfect. Don’t forget to lift weights. Goal is to develop a competent runner. Evaluation: Did they improve performance? Did they stick to the training schedule?

7. Systems Based Practice • Residents should be evaluated against agreed upon standards. • GME office recommends that residents be judged by how well they meet the Program’s standards. • Faculty should discuss criteria for evaluating residents.

8. Change in requirements. No longer a lone practitioner.

9. It’s a team sport.

10. Systems Based Practice

11. Systems Based Practice • The whole has one or more defining functions. • Each part can affect the behavior or properties of the whole. • Each part is necessary but alone is insufficient to carry out the defining function of the whole. • Behavior and properties of one part of the system depend on the behavior and properties of at least one other part of the system.

12. Systems Based Practice • WHO’ s “High 5” • 1. Concentrated injectable meds. • 2. Med accuracy at transitions of care. • 3. Communications during handovers. • 4. Improving hand hygiene. • 5. Correct site for procedures. • Cost is next.

13. Best/faster runners in the world but they dropped the baton so their speed doesn’t matter.

14. Residents must demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value. Residents are expected to: Know how types of medical practice and delivery systems differ from one another, including methods of controlling health care costs and allocating resources Practice cost effective health care and resource allocation that do not compromise quality of care Advocate for quality patient care and assist patients in dealing with system complexities Partner with health care managers and health care providers to assess, coordinate Systems Based Practice

15. Systems Based Practice • Describe the learning activity(ies) through which residents achieve competence in the elements of systems-based practice: work effectively in various health care delivery settings and systems, coordinate patient care within the health care system; incorporate considerations of cost-containment and risk-benefit analysis in patient care; advocate for quality patient care and optimal patient care systems; and work in interprofessional teams to enhance patient safety and care quality. • Limit your response to 400 words. PIF language

16. Examples of Learning Activities: • Didactic Lectures, • Assigned Reading, • Seminars, • self-directed learning module, • Conferences (M&M), • Small Group Discussions, • Workshops, • Online Modules, • journal club, • project, • Case Discussions, • one-on-one mentoring

17. Systems Based Practice • Describe an activity that fulfills the requirement for experiential learning in identifying system errors. • Limit your response to 400 words. PIF language

18. Examples of activities … • Root cause analysis. • Improvement in care based upon a systems change. • Analysis/improvement of transitions of care. • Analysis/change in the use of referrals or of diagnostic test.

19. Advocate for patient care • Didactic presentations on insurance benefits. • Advise patients about necessary insurance benefits.

20. Partner with others • Work with 3rd party payers. • Know how the hospital is paid. • Teach patients about their insurance benefits.

21. Systems Based Practice • Goal: • To be aware of and responsive to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value.

22. Systems Based Practice • Objectives: • Residents will consult services effectively. • Residents will participate in multidisciplinary care. • Residents will understand the patient’s insurance. • Residents will know their “place” in the system(s). • Residents will practice efficient medical care.

23. Systems Based Practice • Faculty need “anchors.” • Provide clear guidance. • Feedback based on objectives. • Evaluations based on objectives.

24. Systems Based Practice • Team player. • Multidisciplinary rounds. • Nurses evaluation of residents. • Quality assessment improvements. • Look for ways to improve patient care by changing a system. This slide and the next 2 are the 3 examples.

25. Practice cost effective medicine • Teach the cost of care. • Do audits of care. • Look for ways to reduce cost. • Implement reduced costly care. • Consider cost when prescribing. • Study means to reduce cost while maintaining quality.

26. Know about cost and allocating resources • Didactic presentations. • Study cost of difference Rx’s. • Finds means to reduce LOS and/or reduce readmissions. • Consider cost/benefit of diagnostic tests.

27. Systems Based Practice • 1. Documented multisystem care teams. • 2. Have residents involved in QA. • 3. Have resident involved in systems improvements.

28. Thank you • Dempsey Springfield, MD • Associate Director Partners GME • dspringfield@partners.org