Preliminary Feedback from
ACGME CLER Site Visit
August 19-21, 2014
2014 Program Director Retreat
Alan J. Smith, PhD, MEd
Assistant Dean and Director for GME
ACGME Designated Institutional Official (DIO)
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Components of the ACGME Next
Accreditation System (NAS)
Annual Data Collection and Review
Milestones
10 year Self-Study Visit
prn Site Visits (Program or Institution)
Continuous RRC and IRC Oversight and Accreditation
Clinical Learning Environment Review
CLER Visits
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CLER
• CLER emphasis on responsibility of the sponsoring
institution for the quality and safety of the
environment for learning and patient care.
• Assessment in six focus areas: Patient Safety; Quality
Improvement; Transitions in Care; Supervision; Duty
Hours Oversight, Fatigue Management and
Mitigation; and Professionalism
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CLER
• The visit addressed the following questions:
– What organizational structures and administrative and
clinical processes does the hospital have in place to
support GME learning in each of the six focus areas?
– What is the role of GME leadership and faculty to
support resident and fellow learning in each of the six
areas?
– How comprehensive is the involvement of residents
and fellows in using these structures and processes to
support their learning in each of the six areas?
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We were
#203
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CLER Visit Structure
• Visit involved only University Hospital; future visits may involve
other clinical sites and affiliated hospitals.
• Visit began with CLER team meeting with senior leadership group:
CEO, DIO, CMO, CNO, GMEC Chair, and resident GMEC member.
• Additional group meetings with residents and fellows, program
faculty, program directors, senior leaders of patient safety and
quality management.
• Series of one-on-one discussions with individual residents and staff
(e.g., nursing) on 4 walking tours of various clinical sites within the
hospital.
• Final debriefing/feedback session with senior leadership group.
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Impressions from CLER visit
• CLER team cordial, professional, but tight-lipped.
• Special attention directed towards CEO during
both opening and closing sessions.
• Emphasis on role of patient safety/quality
improvement personnel in integration of resident
Q/PS projects.
• Much discussion on health care disparities &
need for hospital plan.
• Team observed transitions of care in multiple
clinical areas; noted need for standardized
process.
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Oral Report:
Quality and Patient Safety
• Need to increase awareness of hospital’s strategic goals
for quality and patient safety among residents, faculty
and program directors.
• Address under-reporting of errors & near misses by
residents and faculty; over reliance on nurses to report;
provide feedback; implement new system & train in
use.
• Increase understanding of the range of reportable
events among residents, faculty and program directors
(i.e., what should be reported).
• Increase understanding of quality & patient safety
“terms” among all groups.
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Oral Report:
Quality and Patient Safety
• Noted differences among residents, faculty
and program directors regarding knowledge of
hospital’s quality/patient safety priorities.
• Standardize time outs for bedside procedures.
• Link resident Q/PS projects to hospital
strategic goals.
• Increase opportunities for interprofessional
Q/PS projects.
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Oral Report:
Transitions of Care
• Develop common approach across clinical
areas for hand offs (e.g., standard acronym for
hand offs).
• Increase attending monitoring and
participation in hand offs.
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Oral Report: Supervision
• Implement supervision process to reduce
situations where lack of supervision can lead
to patient safety events.
• Develop objective, accessible system for
attending physicians & nurses to know
resident competencies for performing
procedures.
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Oral Report: Duty Hours/Fatigue
Management & Mitigation
• Provide areas where residents can nap/rest
when fatigued.
• Better education and monitoring of fatigue;
reduce tendency to “power through” when
fatigued.
• Closer monitoring of moonlighting hour
reporting.
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Oral Report: Professionalism
• Reduce incidents of unprofessional behavior
among faculty; provide faculty
development/education on professionalism.
• Clarify and educate residents about process
for reporting mistreatment/unprofessional
behavior.
• Promote culture of professionalism.
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Oral Report:
Healthcare Disparities
• Develop institutional plan for identifying and
addressing healthcare disparities.
• Communicate hospital’s priorities for
addressing healthcare disparities to residents,
faculty and PDs.
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Written Report 6-8 weeks after visit
• Report will contain raw data (responses) from
resident, faculty and program director responses in
group sessions (audience response system).
• Observations from interactions with residents,
faculty, nurses & others during walk-arounds.
• Information from meetings with leadership and
QI/Patient Safety staff.
• Provides reflections and observations rather than
recommendations.
• We will have opportunity to respond (optional).
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What the report might look like …
(example from Fletcher Allen Healthcare, University of VT)
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Next Steps
• Assess findings and recommendations in the
CLER written report.
• Prioritize and implement improvements and
measure outcomes.
• Incorporate improvements into annual
program and institutional reviews/reports.
• Incorporate CLER Pathways to Excellence.
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Sincere thanks to everyone who
participated in the CLER site visit!
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