Systems Based Practice
(SBP)
Dempsey Springfield, MD
Associate Director for Partners
GME
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Conflicts of Interest
• Member of Orthopaedic Dept. at MGH
• Associate Director for Partners GME
• Deputy Editor for Journal of Bone and
Joint Surgery
• No financial interest in products related to
Systems-based Practice.
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Teach
Evaluate
Declare
competent.
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Competency Based Education
• Competency-based education focuses
on learner performance in reaching
specific objectives.
• Not could they have learned but did
they learn.
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Goals & Objectives
• Goals are broad; objectives are narrow.
•
Goals are general intentions; objectives are precise.
• Goals are intangible; objectives are tangible.
•
Goals are abstract; objectives are concrete.
• Goals can't be validated as is; objectives can be
validated.
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Objective is to run 5-6 miles 4
days per week and sprints 2
days per week for the 6 months
prior to the race.
Feedback: You need to pick up your
pace on long runs. Your sprint days
are perfect. Don’t forget to lift weights.
Goal is to develop a
competent runner.
Evaluation: Did they improve
performance? Did they stick to the
training schedule?
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Systems Based Practice
• Residents should be evaluated against
agreed upon standards.
• GME office recommends that residents
be judged by how well they meet the
Program’s standards.
• Faculty should discuss criteria for
evaluating residents.
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Change in requirements.
No longer a lone practitioner.
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It’s a team sport.
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Systems Based Practice
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Systems Based Practice
• The whole has one or more defining functions.
• Each part can affect the behavior or properties of the
whole.
• Each part is necessary but alone is insufficient to carry
out the defining function of the whole.
• Behavior and properties of one part of the system
depend on the behavior and properties of at least one
other part of the system.
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Systems Based Practice
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WHO’ s “High 5”
1. Concentrated injectable meds.
2. Med accuracy at transitions of care.
3. Communications during handovers.
4. Improving hand hygiene.
5. Correct site for procedures.
• Cost is next.
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Best/faster runners in the world but they dropped the
baton so their speed doesn’t matter.
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Systems Based Practice
• Residents must
demonstrate an
awareness of and
responsiveness to the
larger context and system
of health care and the
ability to effectively call
on system resources to
provide care that is of
optimal value.
• Residents are expected
to:
1.
2.
3.
4.
Know how types of medical
practice and delivery systems
differ from one another,
including methods of controlling
health care costs and allocating
resources
Practice cost effective health
care and resource allocation that
do not compromise quality of
care
Advocate for quality patient care
and assist patients in dealing
with system complexities
Partner with health care
managers and health care
providers to assess, coordinate
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Systems Based Practice
• Describe the learning activity(ies) through which
residents achieve competence in the elements of
systems-based practice: work effectively in various
health care delivery settings and systems, coordinate
patient care within the health care system; incorporate
considerations of cost-containment and risk-benefit
analysis in patient care; advocate for quality patient care
and optimal patient care systems; and work in
interprofessional teams to enhance patient safety and
care quality.
• Limit your response to 400 words.
PIF language
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Examples of Learning Activities:
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Didactic Lectures,
Assigned Reading,
Seminars,
self-directed learning module,
Conferences (M&M),
Small Group Discussions,
Workshops,
Online Modules,
journal club,
project,
Case Discussions,
one-on-one mentoring
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Systems Based Practice
• Describe an activity that fulfills the
requirement for experiential learning in
identifying system errors.
• Limit your response to 400 words.
PIF language
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Examples of activities …
• Root cause analysis.
• Improvement in care based upon a
systems change.
• Analysis/improvement of transitions of
care.
• Analysis/change in the use of referrals or
of diagnostic test.
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Advocate for patient care
• Didactic presentations on insurance
benefits.
• Advise patients about necessary
insurance benefits.
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Partner with others
• Work with 3rd party payers.
• Know how the hospital is paid.
• Teach patients about their insurance
benefits.
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Systems Based Practice
• Goal:
• To be aware of and responsive to the larger
context and system of health care and the ability
to effectively call on system resources to provide
care that is of optimal value.
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Systems Based Practice
• Objectives:
• Residents will consult services effectively.
• Residents will participate in multidisciplinary
care.
• Residents will understand the patient’s
insurance.
• Residents will know their “place” in the
system(s).
• Residents will practice efficient medical care.
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Systems Based Practice
• Faculty need “anchors.”
– Provide clear guidance.
• Feedback based on objectives.
• Evaluations based on objectives.
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Systems Based Practice
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Team player.
Multidisciplinary rounds.
Nurses evaluation of residents.
Quality assessment improvements.
– Look for ways to improve patient care by
changing a system.
This slide and the next 2 are the 3
examples.
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Practice cost effective medicine
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Teach the cost of care.
Do audits of care.
Look for ways to reduce cost.
Implement reduced costly care.
Consider cost when prescribing.
Study means to reduce cost while
maintaining quality.
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Know about cost and allocating
resources
• Didactic presentations.
• Study cost of difference Rx’s.
• Finds means to reduce LOS and/or reduce
readmissions.
• Consider cost/benefit of diagnostic tests.
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Systems Based Practice
• 1. Documented multisystem care teams.
• 2. Have residents involved in QA.
• 3. Have resident involved in systems
improvements.
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Thank you
• Dempsey Springfield, MD
• Associate Director Partners GME
• dspringfield@partners.org
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