Posted: June 9, 2014

"Try it, You'll Like It" - Development of a House Staff-Leadership Collaborative


In the summer of 2013, Vanderbilt began an initiative to meet the challenges of a rapidly changing health care system which not only addressed the operational efficiency of the hospital, but also focused on improving processes that would enable it to provide safer, patient-centered, high-value health care. At the same time, the Accreditation Council for Graduate Medical Education (ACGME) began looking into how well residents and clinical fellows were integrated into institutional quality improvement and patient safety initiatives as part of its Clinical Learning Environment Review (CLER). It was quickly recognized that there was opportunity to incorporate the unique "front line" perspectives of the house staff in the hospital's quality and efficiency initiative. Therefore, the DIO and resident-led House Staff Advisory Committee (HSAC) invited the "C-Suite" – the Chief Operating Officer, the Chief Medical Informatics Officer, and Chiefs of Staff – to discuss the house staff's perspective on potential process improvement opportunities. The richness of this initial meeting led the hospital leadership to establish weekly meetings with groups of house officers as an ongoing forum for house staff to connect directly with the C-Suite and medical center leadership. Residents and fellows from (peri)-operative specialties meet with the hospital leadership on the first Monday of the month, followed by internal medicine and neurology house staff on the second Monday, and Pediatric house staff on the third Monday. Importantly, all departments are represented at one of the three meetings. The fourth Monday is reserved for the hospital leadership to meet and to recap the lessons learned from the prior meetings, plan next steps, and prepare action plans to present to the house staff at the following month's meetings. Having started in December 2013, this forum promises to be very valuable in helping Vanderbilt improve the quality of our care delivery across the medical center. There are almost 60 residents and fellows involved in these dialogues across the three meetings. These meetings allow resident representatives to give feedback to hospital leadership both on problems they have recognized and potential solutions, thus deeply integrating the residents/fellows with the C-Suite in process and quality improvement. Although it is early in its history, the HLC efforts have identified several key themes for the medical center to address including nursing-physician communication, optimization of communication technologies, streamlining medicine reconciliation efforts and discharge processes, and potential improvements in the displaying of lab results. The medical center leadership has gained an important perspective on the utility of house staff involvement in process improvement efforts and thus has begun reaching out to the DIO and the HLC to involve residents and fellows in other, non-HLC generated process improvement efforts, including teams addressing standardization of nursing medication administration times, improving geographic localization of patients admitted to various services, and vetting rapid work flow redesign project priorities for the medical center.

*Presented at the 2014 Integrating Quality (IQ) Meeting


Process Improvement, Quality, ACGME, Housestaff, Value, Vanderbilt, CLER, PQI


Josh M. Heck, Vanderbilt University School of Medicine

Wade Iams, MD, Vanderbilt University School of Medicine

Donald Brady, MD, Vanderbilt University School of Medicine