Radiology Resident Quality Training
Program
Paul Nagy, PhD
Fauzia Vandermeer, MD
Charles Resnik, MD
Systems-Based Practice
“Very few doctors understand what is
happening to the health care system in
which they practice, why the system is
changing so rapidly, and what they can do
about it.”
Relman, Academic Medicine, 1998
Goals
• Non didactic physician leadership training
• Lightweight practical training in quality
methods
• Create a learning culture of quality
• Leverage IT as important tool for quality
We do the big things well
• Exponential growth in medical knowledge
• Technological marvels abound in Radiology
The downsides
• Technology has sterilized relationships
• Continual subspecialization challenge
consistency and coordination of care in the
24/7 world.
Death by a thousand cuts
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Coordination
Handoffs
Feedback
Collaboration
Communication
Checklists
Follow up
The cumulative affect of small barriers
inhibit these important behaviors.
Quality Manifesto
• A learning culture is built by launching 100’s of
small projects to fix the cracks in our system.
• Large multiyear system upgrades merely
enable a higher potential. You still need to roll
up your sleeves and customize it to your local
workflow and culture.
• What are you waiting for?
ACGME Systems-based Practice
Residents must demonstrate an awareness of and responsiveness to
the larger context and system of health care, ..
Residents are expected to:
(5) work in interprofessional
improve patient care quality; and,
teams to enhance patient safety and
(6) participate
in identifying system errors and
implementing potential systems solutions.
(8) be trained to identify existing systems problems that compromise their
ability to provide the most efficient and effective patient care. They must be
trained to analyze systematically the problems,
develop solutions, implement solutions, and
evaluate the effectiveness of the intervention.
“Program Requirements ACGME Radiology”
Education in practice mgmt
“When the researchers compared the
five-year results from two medical
schools, they found that students were
significantly more satisfied with their
education.”
Example (Patient Consent Forms)
• Not applicable
– DNAR
• Procedures by team
members
• Permission to
destroy organs
• Potentially confusing
for patient,
radiologist
Resident Quality Requirements
• Core Curriculum in Quality
– Attend Quality Academy for didactic training in
Quality Management
– Participate in Peer Review conference
– Perform one Quality Improvement Project
– Present Quality Improvement Project at the
Quality Academy
• Satisfies ACGME requirements for Practicebased Learning and Improvement and
Systems-based Practice
Resident Projects
Not another rotation!
Projects are self paced (6 months - 2 years)
Often they come up with their own problem
We provide resources and mentoring.
Residency directors kept in the loop
Hand off to staff at completion
Up to residents to take initiative
Steps to a quality project
Researching problem
Literature search
Read quality material
Collect & Analyze data
Understand problem
Group exercises
Communicate with team
Develop intervention
Create team
Define problem
Map workflow
Identify barriers
Identify data
Document Meetings
6-8 Hrs
4-6 Hrs
Verify solution
Present at Academy
Publication (+40)
Collect & Analyze data
Test solution
Meet with team
Communicate with team
Develop intervention
Document Improvement
10-12 Hrs
Effort (hrs)
6-8 Hrs
4-6 Hrs
Project List
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Patient Consent Forms
Mild contrast reaction medication access
Surgical followup
Pathology biopsy concordance
OR miscount handoff
ED Pneumonia
ED appropriateness of CT orders
Delayed study sending into PACS
Resident dictation accuracy
ACR appropriateness guidelines
Interventional resident consult checklist
Uncompleted studies delaying reporting process
Tools
People
Tools
Process
UM PACS Context Button
Portal.radiology.umm.edu
Context Integrated Form Manager
Radtracker.radiology.umm.edu
Technologist Report Cards
Resident Review
• Interpretation review
• Technical accuracy review
• Automated report
change detection
Processes
Take a set of activities and
intertwining them to make an
engine for quality.
People
Tools
Process
Internally Promoting Quality
Calendar of Events
Meeting Agendas
Quality Mission
Roles and Members
Committee Minutes
Project Templates
Links to Quality Tools
Project Templates
Engine of Quality
Identify Issues:
Operations
Safety Walk
Peer Review
Identify
Improve
Work on Issues:
Image Quality
Satisfaction
Quality Clinic
Present and
Control
Present and Control:
Quality Academy
Operations
Six Sigma/ Lean Certification
• Special Elective
• Elective requirements also developed to provide more in
depth training in all “pillar” areas for residents interested in
pursuing further study
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Reading list on Quality
Attend one Operations meeting
Attend one Quality Leadership meeting
Attend one Image Quality meeting
Participate in safety walkabout inspection
Perform a survey design exercise
Submit an abstract on a project to a national meeting
Submit a peer review manuscript for publication
Act as a mentor to a junior resident on a Quality Project
Univ of Maryland Results
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25/32 residents have started a project
11 2009 Abstracts to RSNA
7 2009 Presentations on quality at RSNA
Six Sigma/Lean certification