Schreyer Kraftin E, Coull Susan, Pitt Henry A, Freeman Susan L
Department of Emergency Medicine, Temple University Hospital and Temple University Hospital-Episcopal Campus, Philadelphia, PA.
Department of Graduate Medical Education, Lewis Katz School of Medicine at Temple University, and Associate Hospital Director for Medical Education, Temple University Hospital, Philadelphia, PA.
Ochsner J. 2018 Summer;18(2):164-169. doi: 10.31486/toj.18.0006.
As hospital leaders work to meet national performance improvement (PI) priorities and provide high-value healthcare, aligning house staff goals with those of the hospital organization becomes necessary. A hospital leadership goal is to achieve the Institute for Healthcare Improvement (IHI) Triple Aim with the delivery and measurement of high-value care through various PI frameworks, including the domains of the University HealthSystem Consortium (UHC), now Vizient. However, most house staff develop PI projects within their departments, and these projects do not always align with hospital priorities. We sought to determine the extent of alignment between the house staff and the hospital.
An inventory of house staff projects determined by survey responses from house staff and lists provided by program directors and chairs was compiled during a 2-year period. A team of quality experts mapped all house staff projects to the UHC domains of care and to the IHI Triple Aim and then performed a gap analysis.
A total of 184 projects representing 24 departments were identified. Most projects (38%), representing 18 departments, were categorized in the UHC Safety domain. The remaining projects were categorized into the domains of Efficiency (23%), Patient Centeredness (12%), Effectiveness (12%), Equity (8%), and Mortality (7%). Many departments did not have projects in all domains.
We created unique and concise graphic representations of individual house staff projects aligning with hospital initiatives. Our framework generated an action plan for a proactive approach for continually aligning future house staff PI projects with the hospital goals and national healthcare agendas.
随着医院领导努力实现国家绩效改进（PI）优先事项并提供高价值医疗服务，使住院医师的目标与医院组织的目标保持一致变得必要。医院领导的一个目标是通过各种PI框架，包括大学卫生系统联盟（UHC，现更名为Vizient）的领域，实现医疗改进研究所（IHI）的三重目标，即提供并衡量高价值医疗服务。然而，大多数住院医师在其所在科室开展PI项目，而这些项目并不总是与医院的优先事项一致。我们试图确定住院医师与医院之间的一致程度。
在两年期间，通过住院医师的调查回复以及项目主任和科室主任提供的清单，编制了一份住院医师项目清单。一组质量专家将所有住院医师项目映射到UHC的医疗领域和IHI三重目标，然后进行差距分析。
共确定了代表24个科室的184个项目。大多数项目（38%，代表18个科室）被归类到UHC安全领域。其余项目被归类到效率（23%）、以患者为中心（12%）、有效性（12%）、公平性（8%）和死亡率（7%）领域。许多科室并非在所有领域都有项目。
我们创建了与医院倡议相一致的住院医师个人项目的独特且简洁的图形表示。我们的框架生成了一个行动计划，用于采取积极主动的方法，使未来住院医师的PI项目持续与医院目标和国家医疗议程保持一致。
