Moderator: Marlene R. Miller, MD, MSc, FAAP Vice President, Quality

The American Board of Pediatrics:Efforts in Patient Safety and Maintenance of CertificationWednesday, December 5, 200712:00 – 1:00 p.m. EST

Moderator: Marlene R. Miller, MD, MSc, FAAP Vice President, Quality National Association of Children’s Hospitals and Related Institutions (NACHRI) Alexandria, Virginia

This activity was funded through an educational grant from the Physicians’ Foundation for Health Systems Excellence.

Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities Grid The AAP CME program aims to develop, maintain, and increase the competency, skills, and professional performance of pediatric healthcare professionals by providing high quality, relevant, accessible and cost-effective educational experiences. The AAP CME program provides activities to meet the participants’ identified education needs and to support their lifelong learning towards a goal of improving care for children and families (AAP CME Program Mission Statement, August 2004). The AAP recognizes that there are a variety of financial relationships between individuals and commercial interests that require review to identify possible conflicts of interest in a CME activity. The “AAP Policy on Disclosure of Financial Relationships and Resolution of Conflicts of Interest for AAP CME Activities” is designed to ensure quality, objective, balanced, and scientifically rigorous AAP CME activities by identifying and resolving all potential conflicts of interest prior to the confirmation of service of those in a position to influence and/or control CME content. The AAP has taken steps to resolve any potential conflicts of interest. All AAP CME activities will strictly adhere to the 2004 Updated Accreditation Council for Continuing Medical Education (ACCME) Standards for Commercial Support: Standards to Ensure the Independence of CME Activities. In accordance with these Standards, the following decisions will be made free of the control of a commercial interest: identification of CME needs, determination of educational objectives, selection and presentation of content, selection of all persons and organizations that will be in a position to control the content, selection of educational methods, and evaluation of the CME activity. The purpose of this policy is to ensure all potential conflicts of interest are identified and mechanisms to resolve them prior to the CME activity are implemented in ways that are consistent with the public good. The AAP is committed to providing learners with commercially unbiased CME activities.

DISCLOSURES

CME CREDIT The American Academy of Pediatrics (AAP) is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AAP designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity. This activity is acceptable for up to 1.0 AAP credit. This credit can be applied toward the AAP CME/CPD Award available to Fellows and Candidate Fellows of the American Academy of Pediatrics.

OTHER CREDIT This webinar is approved by the National Association of Pediatric Nurse Practitioners (NAPNAP) for 1.2 NAPNAP contact hours of which 0.0 contain pharmacology (Rx) content. The AAP is designated as Agency #17. Upon completion of the program, each participant desiring NAPNAP contact hours should send a completed certificate of attendance, along with the required recording fee ($10 for NAPNAP members, $15 for nonmembers), to the NAPNAP National Office at 20 Brace Road, Suite 200, Cherry Hill, NJ 08034-2633. The American Academy of Physician Assistants accepts AMA PRA Category 1 Credit(s)TM from organizations accredited by the ACCME.

Paul V. Miles, MD, FAAP Vice President Director of Quality and Practice Assessment The American Board of Pediatrics Chapel Hill, North Carolina

Learning Objectives Upon completion of this activity, you will be able to: • Discuss the role of the American Board of Pediatrics (ABP) in improving children’s health care quality and safety. • Apply the new Maintenance of Certification process to your own individual situation. • Describe the role of the ABP in specific projects to improve knowledge and delivery of safe care to children.

Patient Safety as a Professional Competency The American Board of Pediatrics: Efforts in Patient Safety and Maintenance of Certification Safer Health Care for Kids Webinar Dec 5, 2007 Paul V. Miles MDVice President for Quality and Practice Assessment American Board of Pediatrics

To Err is Human: The IOM recommended that standards for provider competence and knowledge of patient safety be developed and that assessment and reassessment on a periodic basis be done. P Miles ABP

“The ability to assess and systematically improve the safety of medical practice is an essential competency of every certified physician.” …..ABMS-CMSS Joint Planning Committee, December 2002 P Miles ABP

Six Core Physician Competencies Applied to Patient Safety • Patient care • Medical knowledge • Interpersonal and communication skills • Professionalism • Practice-based learning and improvement • Systems-based practice (Adopted by the ACGME and all twenty four ABMS specialty boards) P Miles ABP

Person Approach vs. System Approach “Naturally enough, the associated countermeasures are directedmainly at reducing unwanted variability in human behavior. Thesemethods include poster campaigns that appeal to people's senseof fear, writing another procedure (or adding to existing ones),disciplinary measures, threat of litigation, retraining, naming,blaming, and shaming. Followers of this approach tend to treaterrors as moral issues, assuming that bad things happen to badpeople what psychologists have called thejust world hypothesis.1” P Miles ABP Reason, J BMJ 2000;320:768-770 ( 18 March )

Person Approach vs. System Approach “The basic premise in the system approach is that humans are fallible and errors are to be expected, even in the best organizations.Errors are seen as consequences rather than causes, having theirorigins not so much in the perversity of human nature as in "upstream"systemic factors.” P Miles ABP Reason, J BMJ 2000;320:768-770 ( 18 March )

Dreyfus Model for Learning • Novice • Advanced beginner • Competent • Proficient • Expert P Miles ABP

Medical Career Continuum • Novice………………………Medical student • Advanced beginner…….Beginning resident • Competent………..…………Senior resident • Proficient………….…7-10 years into career • Expert……...…....Senior faculty/practitioner P Miles ABP

Improvement Focus Educational System Improvement Number of Pediatricians Residents Faculty Standard Novice – Competent - Expert P Miles ABP

Team and System Competency • The same progression from novice to expert applies to teams and microsystems • The ABP will accept team data for certification of individuals P Miles ABP

Personal Competency and Quality Care J. Bingham & D. Quinn Vanderbilt P Miles ABP

Personal Competency and Patient Safety P Miles ABP

Competency in Teamwork • Team Knowledge: • Knowledge about components of teamwork • Shared models • Knowledge of teammate characteristics • Knowledge of team mission, norms, objectives, and resources • Task-specific responsibilities Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005 P Miles ABP

Competency in Teamwork • Skills: • Closed-loop communication • Team leadership • Mutual performance monitoring • Backup behavior • Adaptability • Attitudes: • Belief in the importance of teamwork • Mutual trust • Team orientation Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005 P Miles ABP

Measurement of Team Performance • Must be grounded in team theory • Must account for individual and team-level performance • Must capture team process and outcomes • Must adhere to accepted standards for reliability and validity • Must address and real or perceived barriers to measurement Baker et al J Comm J Qual Patient Saf 31:185-202, Apr. 2005 P Miles ABP

ABP Maintenance of Certification Version 1.1: Requirements Part 1: License Part 2: Knowledge & Decision Skills SA Part 3: Secure examination Part 4: Component A – Patient Survey Component B – Approved activity P Miles ABP

Version 1.1: How much time? 7-year certificate NOTE: Approximate times are actual “seat” time and do not include preparation time P Miles ABP

What is Part 4? • Component A • Patient Survey • Component B • Option 1: Approved web-based module • AAP eQIPP modules • Patient Safety module • PIM module + self-assessment combination package • eg. Asthma PIM + QI Self-assessment • Option 2: Approved collaborative • eg. VON project + QI Self-assessment + Note: Activities listed under the Component B options are for example purposes only; other activities exist. P Miles ABP

A Proposal to Design, Develop, and Deploy aWeb-based Patient Safety Education and Improvement Module That Will Meet the Requirements for Part 4 Maintenance of Certification TM

A Collaborative Effort • ABMS – lead organization • ABP/AAP • ABFP/AAFP • ABIM/ACP • Surgery, anesthesiology, other specialties • VA, DoD, AHRQ, • National experts on patient safety P Miles ABP

Features • Designed to work for all 650,000+ board certified physicians across 24 specialties • Designed to work for non practicing physicians • Before and after knowledge self assessment • Quality improvement approach • Designed to work with local improvement efforts • Hot Links to key Patient Safety Web sites P Miles ABP

www.abms.org P Miles ABP

ABMS Patient Safety Improvement Program www.abms.org P Miles ABP

Other ABP Safety Initiatives • Patient safety content in certifying exams and other parts of the certifying process • ABP approval of patient safety improvement projects to meet the requirements for MOC Part 4 • Alliance for Pediatric Quality has selected patient safety as one of the three initial Improve First initiatives P Miles ABP

Eliminating Bloodstream Infections NACHRI CA-BSI Collaborative In the first 6 months, 29 children’s hospitals reduced infection ratesin the PICU by nearly 70 percent by adhering to a rigid set of evidence-based practices shown to prevent infections in children. 70% improvement: estimated 20 lives saved, 160 infections prevented, $6.4 million not spent in the first 6 months P Miles ABP

Resources for Patient Safety • AHRQ Web M&M site www.ahrq.gov • To Error is Human IOM • Creating systems of safe care IOM • To Do No Harm – Julie Morath • ABMS Web-based patient safety module P Miles ABP

Now What?!?Some take-away points from the Webinar: • The ABMS Patient Safety Program is valuable for all physicians • Participate in a local, regional or national safety improvement project • Engage in the AAP Safer Health Care for Kids effort • Create a culture of safety in your practice • Maintain board certification

Moderator: Marlene R. Miller, MD, MSc, FAAP Vice President, Quality