title: Quality and Safety in Orthopaedics: Learning and Teaching at the Same Time: AOA Critical Issues.
abstract: Increasing attention has been placed on providing higher quality and safer patient care. This requires the development of a new set of competencies to better understand and navigate the system and lead the orthopaedic team. While still trying to learn and develop these competencies, the academic orthopaedist is also expected to model and teach them.The orthopaedic surgeon must understand what is being measured and why, both for purposes of providing better care and to eliminate unnecessary expense in the system. Metrics currently include hospital-acquired conditions, "never events," and thirty-day readmission rates. More will undoubtedly follow.Although commitment and excellence at the individual level are essential, the orthopaedist must think at the systems level to provide the highest value of care. A work culture characterized by respect and trust is essential to improved communication, teamwork, and confidential peer review. An increasing number of resources, both in print and electronic format, are available for us to understand what we can do now to improve quality and safety.Resident education in quality and safety is a fundamental component of the systems-based practice competency, the Next Accreditation System, and the Clinical Learning Environment Review. This needs to be longitudinally integrated into the curriculum and applied parallel to the development of resident knowledge and skill, and will be best learned if resident learning is experiential and taught within a genuine culture of quality and safety.
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, EC089, Hershey, PA 17033. E-mail address for K.P. Black: kblack@hmc.psu.edu. E-mail address for A.D. Armstrong: aarmstrong@hmc.psu.edu.
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Black
authors.affiliation: Department of Orthopaedics and Rehabilitation, Penn State Milton S. Hershey Medical Center, 30 Hope Drive, EC089, Hershey, PA 17033. E-mail address for K.P. Black: kblack@hmc.psu.edu. E-mail address for A.D. Armstrong: aarmstrong@hmc.psu.edu.
authors.forename: April D
authors.initials: AD
authors.lastname: Armstrong
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, 301 East 17th Street, Room 1402, New York, NY 10003. E-mail address for L. Hutzler: Lorraine.hutzler@nyumc.org. E-mail address for K.A. Egol: kenneth.egol@nyumc.org.
authors.forename: Lorraine
authors.initials: L
authors.lastname: Hutzler
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, 301 East 17th Street, Room 1402, New York, NY 10003. E-mail address for L. Hutzler: Lorraine.hutzler@nyumc.org. E-mail address for K.A. Egol: kenneth.egol@nyumc.org.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Egol
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D009985:Orthopedics / Q000193:education*; D061214:Patient Safety; D011787:Quality of Health Care; D014481:United States