“ Over the next four years these eight institutions are the testing ground for innovative approaches to crafting effective clinical learning environments that can translate to the more than 800 accredited Sponsoring Institutions”

Kevin B. Weiss, MD, MPH, ACGME Senior Vice President, Institutional Accreditation

The Pursuing Excellence framework from which the Innovators are working is based on overarching findings identified through site visits conducted as part of the ACGME’s Clinical Learning Environment Review (CLER) Program. More information about the results from the CLER Program can be found in the National Report of Findings 2016 Issue Brief No, 1 Executive Summary .

As the Pathway Innovators identify successful practices, they will share their experiences through existing ACGME forums, as well as develop new avenues for sharing with the broader community, encouraging a national discussion about advancing the quality of educational and patient outcomes within health care settings.

The Pathway Innovators will meet three times a year for the next four years, once per year at the ACGME office, and twice per year alternating across the participating institutions, to collaborate and share their progress and findings.

The following are brief descriptions of the initial projects the Pathway Innovators are undertaking in the first phase of the Pursuing Excellence initiative.

Children’s National Medical Center, Washington D.C.

Children’s National will implement an in situ (in the clinical setting) simulation program across the organization to address safety culture and knowledge, common safety language, safety behaviors, and quality improvement to better understand the workforce's knowledge and capacity in patient safety and quality methods, as well as to identify subsequent areas of focus for improvement. The program will be linked to a "Patient Safety Passport" portal that will provide foundational safety knowledge in an interactive electronic environment. The portal will collect, integrate, and aggregate data from the participation of residents, nurses, ancillary staff members, and faculty members to determine the effectiveness of the intervention. Organizational quality, safety, and culture measures will be correlated with the data obtained through the portal and the in situ simulations.

Cleveland Clinic Foundation, Cleveland, OH

The Cleveland Clinic project consists of utilizing resident-led/faculty-coached multidisciplinary teams to explore transitions of care, identify vulnerable components and deficiencies, propose and implement solutions, and finally revisit the individual transition of care to examine the effect of the intervention. The cycle is then repeated until optimization is reached. A curriculum will provide the interdisciplinary team with didactic and workshop-based instruction as the project progresses. A program has already been implemented for a large number of quality improvement projects at Cleveland Clinic and has been successful in optimizing a variety of clinical care delivery processes. Once best practices have been determined, they will be shared within the Cleveland Clinic Health System, and with other institutions.

Dell Seton Medical Center – University of Texas at Austin,
Austin, TX

The Dell Medical School will implement a groundbreaking curriculum that trains residents to provide care centered on patients and their experience. The curriculum and related initiatives will stress ways of increasing efficiency, reducing errors, improving educational outcomes for students, and enhancing patient satisfaction. It will emphasize concepts such as quality, safety, experience, and cost, while framing medical overuse as a patient safety problem. It also will stress teamwork and communication among a range of health providers and professionals to help prevent harm and the use of non-essential services. The program seeks to capitalize on the unique opportunity to create a curriculum from scratch and build a modern teaching hospital around the needs and challenges of 21st century health care, both of which will serve as models for other institutions and communities.

Maine Medical Center (MMC), Portland, ME

MMC will redesign the clinical learning environment to improve interprofessional care and education. Primary goals include: patient-centered care; greater resident engagement in patient safety and quality; enhanced provider and staff well-being and satisfaction; and efficiency of care and education. A centerpiece is the establishment of the iPACE unit (Interprofessional Partnership to Advance Care and Education) – a new 18-bed patient care unit used to create a fundamentally redesigned interprofessional clinical learning and care environment. This includes co-leadership by a nursing director and attending physician, a functionally integrated interprofessional team, and interprofessional team learning that engages systems engineering students and health professionals, and integrates education on systems engineering approaches to understanding and improving care quality. Engineering design methods, simulation modeling, and other operations research tools will be used to assess the potential impact of the redesigned service on care efficiency and quality, and to optimize logistics

Our Lady of the Lake Regional Medical Center, Baton Rouge, LA

Our Lady of the Lake (OLOL) Regional Medical Center will implement an initiative centered on safety education and event reporting (SAFER). The project focuses on increasing event reporting behavior through targeted education and imbedded “on-the-fly” coaching, which will include nurses, physician assistants, PA students, residents, and attending physicians. In order to support and enhance a positive safety culture, an electronic application (app) available to all health care professionals and students will be used. This app allows for provision of positive feedback and acknowledgement of one another as health care professionals in the management and demonstration of safety reporting. OLOL is one of five hospitals within the Franciscan Missionaries of Our Lady Health System (FMOLHS), the largest health care system in Louisiana, and anticipates spreading successful outcomes of this initiative across the system.

Strong Memorial Hospital of the University of Rochester, Rochester, NY

The University of Rochester Medical Center (URMC) plans to integrate its 750 residents into an existing Unit-based Performance Program (UPP) established in 2013 on 42 patient care units in URMC’s Strong Memorial Hospital. Each unit has an UPP team led by a faculty medical director, nurse manager, and staff. The teams develop projects to improve patient outcomes and satisfaction, and advance priorities of quality and safety, patient- and family-centered care (PFCC), and efficiency. In 2018, nearly half the UPP teams reduced the incidence of three types of hospital-acquired infections on their units by at least 10%. Twelve teams decreased these infections by 40% or more. Similar results were achieved in PFCC and efficiency measures. As part of this initiative, URMC will embed residents into UPP teams in every specialty across the hospital. Residents will learn quality and safety principles and apply them to their roles, and over time these will be integrated into all of URMC’s 42 teams.

University of Chicago Medical Center, Chicago, IL

The focus of University of Chicago Medicine’s Pathway Innovator work will build upon the existing IGNITE program (Improving GME Nursing Interprofessional Team Experiences). IGNITE is a partnership between the GME program and nursing that enables frontline nurses and residents to work together to improve interprofessional communication and quality of care. IGNITE brings together staff nurses with residents who have been nominated as exemplars in interprofessional communication to work on quality improvement projects to advance care in their areas. Small pilots of the IGNITE program in pediatrics, medicine, and surgery have earned positive feedback from patients, and Pursuing Excellence will allow the program to build on the momentum of that project. We will evaluate IGNITE and spread it house-wide to other residencies and ambulatory areas, incorporate it into other professions such as pharmacy and social work, and expand the interdepartmental quality improvement and patient safety curriculum to include representatives from these other professions.

University of California San Francisco (UCSF) School of Medicine, San Francisco, CA

UCSF aims to create a seamless integration of residents and fellows into both the unit-based leadership teams (UBLT) and the Lean Management System (LMS). This effort will focus on transitions of care, including from the Emergency Department to inpatient units, the Operating Room to the Intensive Care Unit (ICU), the ICU to the floor, ambulatory practice to the hospital, hospital to home, and many others. Residents and fellows will participate in the identification and design of ideal future state value streams, weekly UBLT works-in-progress seminars, and UBLT huddles and leader rounding on visibility walls. Resident and fellow leadership and integration will lead to improvements in quality, safety, and efficiency that would be difficult to achieve without their participation. This approach will also lead to additional projects to enhance residents’ and fellows’ roles in strategic planning, faculty competence in patient safety and quality improvement, and inter-professional learning.