Residency programs are part of a healthcare organization’s work system

1. Healthy People, Healthy Systems Synthesizing Quality Assurance1 & Systems Engineering2 • Residency programs are part of a healthcare organization’s work system • Addressing the human factors involved with providing care in a complex system is essential to impacting patient outcomes. • Why? To improve patient safety and outcomes; to understand, evaluate and improve resident performance • Four Sub-Projects Tools & Technology Organization Person Tasks Environment 1. The definition of quality and approaches to its assessment. Donabedian, A. Ann Arbor, MI: Health Administration Press; 1980. 2. Systems engineering initiative for patient safety. Pascale Carayon, PhD, Principal Investigator. http://www2.fpm.wisc.edu/seips/index.htm

2. Healthy People, Healthy Systems P1: Performance Evaluation & Quality Improvement Teams Chris Hildebrand, MD, Middleton VA Hospital, WI Goal: To have residents engage in personal reflection on practice Resident Tasks: • Chart audit of patient panel • Compare performance vs. national standard • Develop solutions in QI teams to impact patient outcomes Expected Outcomes: • Resident ability to effect changes in system of care that improves outpatient health outcomes • Improved patient healthcare outcomes Rate of Patient Vaccination by Intern Classes, 2004-07

3. Healthy People, Healthy Systems P2: Improving Patient Safety & Hand-offs Betsy Trowbridge, MD & Geoff Priest, Meriter Hospital, Madison, WI Goal: To have residents learn Quality Assurance & Improvement (QA/QI) principles and apply them to a QI project--a newly-designed handoff process Resident Tasks: • Participate in 2-week QA/QI, systems-based practice training • Learn patient safety practices • Methods of reducing medical error • Participate in QI team developing a newly-designed handoff process • Technology application (EPIC Systems) • Work within a pre-established domain of safe care in the handoff process • Pilot process for impact on resident and patient outcomes Expected Outcomes: • Increased resident understanding of QA/QI process & SBP • Increased resident skills in patient safety, communication and teamwork • Safer patient care processes

4. Healthy People, Healthy Systems P3: Resident Performance & Integration in the Hospital Work System Tosha B. Wetterneck, MD, University of Wisconsin-Madison Goal: To have residents understand and apply the QI process to identify and address performance obstacles and facilitators in work and learning system Resident and Faculty Tasks: • Interviews about work & learning processes • Direct observation of work processes • Use findings to redesign work system • Monitor, assess & modify effects of change Expected outcomes: • Improved quality of work life (QWL), job satisfaction, resident performance & patient core measures • Measures of QWL, job satisfaction and resident performance

5. Healthy People, Healthy Systems P4: Maximizing Evidence-Based Medicine & Outcomes Through an Evidence-Based Practice Intervention David Feldstein, MD, University of Wisconsin-Madison Goal: To integrate Evidence-Based Practice (EBP) into attending rounds and patient care Residents & Faculty: • Participate in professional development • Implement EBP on wards • Apply EBP to patient care and management as members of teams on wards • Measure resident performance, patient outcomes Expected Outcomes: • Process for teaching EBP into attending rounds • Validated tool for evaluating resident skills in applying evidence-based interpretation and decision making • Measures to assess impact on patient satisfaction and outcomes

6. Faculty and Resident Professional Development in: Quality Assurance & Improvement Multi-disciplinary team learning Systems-Based Practice Evidence-Based Practice Monitor learning & patient care processes to ensure maintenance of pre-established standards Multiple methods of evaluation Ensures program goals are being met Multiple observations of the learner Monitor the impact on the organization and patients Deliverables Validated evaluation instruments Learning tools & models Process and project management models Healthy People, Healthy Systems Outcomes of Patients & Trainees in a Model of Industrial & Systems Engineering Common threads run through the fabric of our EIP: