324
the accreditation body of Canada, the Royal College of Physicians and Surgeons of
Canada (RCPSC) [ 4 ]. Despite this requirement, there is no standard for teaching or
incorporating patient safety and quality improvement into a surgical residency cur-
riculum [ 4 , 5 ]. Currently, the extent of QI education varies greatly across surgical
residencies; therefore, there is a clear need to understand logistic and structural fac-
tors that contribute to implementing QI improvement for residents [ 6 ].
This chapter will attempt to summarize available literature regarding trainee
engagement in quality improvement and patient safety initiatives.
Value of Quality Improvement/Patient Safety Programs
Resident engagement in quality improvement initiatives is thought to mutually ben-
efit the organization, the resident’s educational experience, and patient outcomes.
While some projects are purely designed to streamline operations and improve effi-
ciency, many QI projects are focused primarily on patient care. Benefits may include
improvements in patient management outcomes, professional and personal develop-
ment of residents, and more engagement among faculty and trainees [ 7 ].
Establishing a Curriculum
Recently, there has been a focus from program directors, administrators, and other
members of training institutions to establish a formal curriculum in QI/PS. While
many of these curricula are direct responses to ACGME requirements, there also
appears to be a paradigm shift within residency training to focus more on patient
outcomes, patient satisfaction, and improved relations between colleagues. Several
studies have attempted to focus not only on outlining specific examples of success-
ful projects but also outlining a framework for establishing a sustainable curriculum
at any training institution.
Canal et al. (2007) outlines a set of four steps for establishing continuous quality
improvement, including (1) identifying areas for improvement, (2) engaging in
learning, (3) applying new knowledge and skills to practice, and (4) checking improve-
ment. The study also offers a template for continuous quality improvement projects
that assures that projects will remain goal-oriented and be more likely to succeed [ 8 ].
Table 19.1 is an example of a template for continuous quality improvement projects
for trainees to use when developing quality improvement/patient safety projects.
Some healthcare institutions have looked to the business world for suggestions
on how to establish quality improvement measures in hospital and residency train-
ing settings. On example of a specific model for quality improvement is the “lean
model,” which is a set of operating philosophies that maximize value for patients by
minimizing waste and waiting [ 10 ]. Adapted from the Toyota corporation and Henry
Ford System on car manufacturing, the lean model has been used in a variety of
healthcare systems to improve patient safety and efficacy, decrease length of stay,
and enhance financial responsibility by identifying ways to decrease material and
E.L. Ferguson and C.P. Sundaram