209on general medicine units. Through this simple intervention, they were able to
reduce mean search times by greater than 90 s, with 92% of participants reporting
that they found supplies more rapidly and 86% reporting less frustration after the
intervention. Educators have reported similar success using Six Sigma and lean
methodology to speed the delivery of hospital discharge documents to primary care
physicians [ 3 ], decrease the time that residents spend rounding while increasing
patient contact time [ 13 ], and develop a more efficient postoperative pathway [ 35 ].
Challenges of Implementing a Quality Improvement Curriculum
While residents, faculty, and healthcare organizations can benefit from implement-
ing QI projects within their institutions, there are several challenges to the imple-
mentation process.
Time
Finding the time to juggle a busy clinical schedule with the demands of an academic
program and work-hour restrictions may leave little room for residents and faculty
members to participate in a QI program. Residents may take advantage of a research
year or elective rotation to complete a QI project, circumstances permitting. A larger
project may require a long-term time commitment that exceeds the time allotted to
a resident during a research rotation or elective or even surpass a resident or faculty
member’s time at the institution. This should be taken into account when selecting
an intervention and the team members to carry out the project.
Education
The first step toward developing a QI project involves educating the team on the
principles and methods of QI. Practice-based learning and improvement teaching
may be delivered during resident teaching conferences, morning report, clinical
case conferences, grand rounds lectures, or integrated into morbidity and mortality
conferences [ 26 , 38 , 43 , 44 , 59 , 68 ]. For institutions that lack the resources or time
to deliver didactic lectures, self-guided online modules may be beneficial [ 11 , 71 ,
74 ]. This allows a centralized educational curriculum that can be used to train resi-
dents and faculty across departments and geographic locations to accommodate
their demanding schedules. The Institute for Healthcare Improvement, US Health
and Human Services Department, and Centers for Disease Control and Prevention
offer several ideas and online resources for institutions interested in QI [ 36 , 72 , 73 ].
Resident Involvement
Resident directly involved in QI reports greater competence in designing and con-
ducting interventions and proficiency in practice-based learning skills [ 9 , 21 , 80 ,
85 ]. The level of resident involvement in part depends on whether an institution
employs a top-down or bottom-up approach. A top-down approach is institution
driven; interventions are chosen at the institutional level, and professionals within
the organization are selected from a range of positions. Residents typically play a
11 The Role of Educators in Quality Improvement