title: Leveraging Trainees to Improve Quality and Safety at the Point of Care: Three Models for Engagement.
abstract: Trainees, as frontline providers who are acutely aware of quality improvement (QI) opportunities and patient safety (PS) issues, are key partners in achieving institutional quality and safety goals. However, as academic medical centers accelerate their initiatives to prioritize QI and PS, trainees have not always been engaged in these efforts. This article describes the development of an organizing framework with three suggested models of varying scopes and time horizons to effectively involve trainees in the quality and safety work of their training institutions. The proposed models, which were developed through a literature review, expert interviews with key stakeholders, and iterative testing, are (1) short-term, team-based, rapid-cycle initiatives; (2) medium-term, unit-based initiatives; and (3) long-term, health-system-wide initiatives. For each, the authors describe the objective, scope, duration, role of faculty leaders, steps for implementation in the clinical setting, pros and cons, and examples in the clinical setting. There are many barriers to designing the ideal training environments that fully engage trainees in QI/PS efforts, including lack of protected time for faculty mentors, time restrictions due to rotation-based training, and structural challenges. However, one of the most promising strategies for overcoming these barriers is integrating QI/PS principles into routine clinical care. These models provide opportunities for trainees to successfully learn and apply quality and safety principles to routine clinical care at the team, unit, and system level.
authors.affiliation: L. Johnson Faherty is Robert Wood Johnson Foundation Clinical Scholar, University of Pennsylvania, and pediatrician, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. K.S. Mate is senior vice president, Institute of Healthcare Improvement, Cambridge, Massachusetts, assistant professor of medicine, Weill Cornell Medical College, New York, New York, and research fellow, Division of Global Health Equity, Harvard Medical School, Boston, Massachusetts. J.M. Moses is academic advisor, Open School, Institute for Healthcare Improvement, Cambridge, Massachusetts; assistant professor of pediatrics, Boston University School of Medicine, Boston, Massachusetts; and director of patient safety and quality, Department of Pediatrics, and medical director of quality improvement, Boston Medical Center, Boston, Massachusetts.
authors.forename: Laura
authors.initials: L
authors.lastname: Johnson Faherty
authors.forename: Kedar S
authors.initials: KS
authors.lastname: Mate
authors.forename: James M
authors.initials: JM
authors.lastname: Moses
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D005180:Faculty, Medical / Q000458:organization & administration*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D008611:Mentors; D008962:Models, Theoretical; D009937:Organizational Objectives; D061214:Patient Safety; D019095:Point-of-Care Systems; D058996:Quality Improvement