SUMMARY
The ACGME has mandated resident involvement in quality improvement (QI) projects without further guidance as to how this should be done. Academic teaching faculty are well versed in the scientific method, but may be less familiar with QI practices. QI differs from traditional science in that there is no hypothesis, rather investigations start from data, determining a baseline and conducting many testing cycles, usually on small, underpowered subgroups. Significant changes are determined when the entire process shifts over time, not by comparing 2 groups after a single intervention. An ideal project will have a SMART aim, which is Specific, Measurable (ideally with frequent, electronic data), Actionable (within the control and influence of your team), Relevant (aligned with the residents’ priorities), and Time bound (restricted to a specific time frame). An example would be “To increase the completeness of ER consult notes from 35% to 80% by June 15, 2016.” Interventions are planned with the aid of a process map with failure mode analysis (Fig. 1). Tests of change are designed in Plan-Do-Study-Act cycles (Fig. 2), targeting small populations for intervention and conducting multiple tests. The data are evaluated continuously over time using a run or control chart to identify statistically significant changes in the process baseline, which guide further testing and alterations to the process (Fig. 3). By targeting an issue that was important to the residents and involving them in the changes and testing, we were able to move our process to goal within 6 months.
Fig. 1.
Process map with failure mode analysis.
Fig. 2.
Planning test cycles.
Fig. 3.
Control chart to evaluate process improvements over time.
Footnotes
Presented at the American Council of Academic Plastic Surgeons Spring Retreat, May 19, 2016, New York, N.Y.
Disclosure: The author has no financial interest to declare in relation to the content of this article. The Article Processing Charge was paid for by the American Council of Academic Plastic Surgeons.
ACAPS: PRS Global Open proudly publishes the abstract and proceedings from the American Council of Academic Plastic Surgeons (ACAPS) Spring Retreat meeting that was held in the Sheraton New York Times Square Hotel, New York, NY on May 19, 2016.