Johnson Faherty Laura, Mate Kedar S, Moses James M
L. Johnson Faherty is Robert Wood Johnson Foundation Clinical Scholar, University of Pennsylvania, and pediatrician, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania. K.S. Mate is senior vice president, Institute of Healthcare Improvement, Cambridge, Massachusetts, assistant professor of medicine, Weill Cornell Medical College, New York, New York, and research fellow, Division of Global Health Equity, Harvard Medical School, Boston, Massachusetts. J.M. Moses is academic advisor, Open School, Institute for Healthcare Improvement, Cambridge, Massachusetts; assistant professor of pediatrics, Boston University School of Medicine, Boston, Massachusetts; and director of patient safety and quality, Department of Pediatrics, and medical director of quality improvement, Boston Medical Center, Boston, Massachusetts.
Acad Med. 2016 Apr;91(4):503-9. doi: 10.1097/ACM.0000000000000975.
Trainees, as frontline providers who are acutely aware of quality improvement (QI) opportunities and patient safety (PS) issues, are key partners in achieving institutional quality and safety goals. However, as academic medical centers accelerate their initiatives to prioritize QI and PS, trainees have not always been engaged in these efforts. This article describes the development of an organizing framework with three suggested models of varying scopes and time horizons to effectively involve trainees in the quality and safety work of their training institutions. The proposed models, which were developed through a literature review, expert interviews with key stakeholders, and iterative testing, are (1) short-term, team-based, rapid-cycle initiatives; (2) medium-term, unit-based initiatives; and (3) long-term, health-system-wide initiatives. For each, the authors describe the objective, scope, duration, role of faculty leaders, steps for implementation in the clinical setting, pros and cons, and examples in the clinical setting. There are many barriers to designing the ideal training environments that fully engage trainees in QI/PS efforts, including lack of protected time for faculty mentors, time restrictions due to rotation-based training, and structural challenges. However, one of the most promising strategies for overcoming these barriers is integrating QI/PS principles into routine clinical care. These models provide opportunities for trainees to successfully learn and apply quality and safety principles to routine clinical care at the team, unit, and system level.
实习生作为一线医疗服务提供者，敏锐地意识到质量改进（QI）机会和患者安全（PS）问题，是实现机构质量和安全目标的关键合作伙伴。然而，随着学术医疗中心加快推进其将QI和PS列为优先事项的举措，实习生并不总是参与到这些工作中。本文描述了一个组织框架的发展过程，该框架提出了三种范围和时间跨度各异的建议模式，以有效地让实习生参与其培训机构的质量和安全工作。这些建议模式是通过文献综述、与关键利益相关者进行专家访谈以及反复测试而制定的，分别为：（1）短期、基于团队的快速循环举措；（2）中期、基于科室的举措；（3）长期、全卫生系统的举措。对于每种模式，作者描述了其目标、范围、持续时间、教员领导的角色、在临床环境中实施的步骤、优缺点以及临床环境中的实例。设计能让实习生充分参与QI/PS工作的理想培训环境存在诸多障碍，包括教员导师缺乏受保护时间、基于轮转培训的时间限制以及结构上的挑战。然而，克服这些障碍最有前景的策略之一是将QI/PS原则融入日常临床护理中。这些模式为实习生提供了机会，使其能够在团队、科室和系统层面成功学习并将质量和安全原则应用于日常临床护理。
