Utilizing resident council leaders to improve the culture of patient care through systematic design of our clinical learning environment


Department of Family Medicine, Department of Obstetrics and Gynecology, Aurora Sinai Medical Center, Care Management, Academic Affairs, Aurora UW Medical Group, Department of Internal Medicine

Presentation Notes

Presented at 2014 Aurora Scientific Day, Milwaukee, WI


Background: The health care landscape continues to evolve, with hospital and resident/fellowship accrediting bodies calling for a culture shift. There have been previous attempts to change this culture, but these have all failed. Alliance for Independent Academic Medical Center’s (AIAMC) National Initiative IV focuses on activating residents as leaders and participants in creating a patient safety and quality culture.

Purpose: This study seeks to evaluate resident involvement as leaders and contributors to our institution’s quality and safety culture at two levels: individual residency programs and across residency programs.

Methods: AIAMC National Initiative IV focuses on activating residents in creating a patient safety and quality culture. Three residency programs were selected to participate in National Initiative IV and required to design a project aimed at improving patient safety/care quality specific to their specialty. Our institution is required to have a Residency Council (RC) comprised of representatives from our resident/fellowship programs. The RC members were charged to serve as culture change leaders for quality/ safety across our institution’s graduate medical education programs.

Results: Each of the three residencies has established an interprofessional program team with project timelines, tasks and roles. Each program team selected a project and finalized our institution’s established and created EPIC-based metrics to monitor improvement: Family Medicine (ambulatory medication reconciliation); Internal Medicine (30-hospital readmission rates); and OB/GYN (labor and delivery patient safety/quality checklists). RC received approval for all incoming residents and fellows to complete five Institute for Healthcare Improvement quality and safety modules as required activities. RC also received Graduate Medical Education Committee (GMEC) approval that a “Synergy Committee” be created to explicitly link quality and safety projects between hospital, clinic and GMEC leadership. RC members now co-present quality and safety curriculum using the GMEC shared noon conference slot.

Conclusion: Bending the culture curve to address quality/ safety through engagement of residents/fellows at individual cross program levels through RC and GMEC can be done. Utilization of National Initiative IV as one of the triggers to spur engagement provides clear deadlines to spur action at program and RC/GMEC levels. Sustaining the program and RC role as culture change leaders and advocates will require additional accountability and leaders to facilitate a change in clinical culture.

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