Residents as Sentinels and Change Agents for Safer Care

This coming Saturday, April 26th, the Committee of Interns and Residents (CIR) will be hosting its next QIIQ Conference titled, “How to be a Lead Agent of Change: From Bedside to Transformative Care“, in NYC. Rosemary Gibson, Carole Hemmelgarn, Shelly Dierking and I have the honor of joining leaders from CIR to help facilitate the all-day interactive session. While many faculty will be attending, the major focus of this educational meeting will be on the residents, both from CIR Hospitals as well as other GME programs, and aligns with the “Educating the Young” mission.

Residents can be change agents for safer, higher quality care. There are now numerous examples across the country of this fact–residents leading important quality and safety initiatives that have reduced risk and raised the quality of care provided–and they have done this work despite internal challenges and long work weeks. Those that have followed our ETY blog for the past two years will remember my post on the work of David Leach, the former CEO for the ACGME (see The Canary in the Coal Mine…).  In one of his publications, Dr. Leach shared the most important role of graduate resident physicians was to act as the “moral agent” for their patients. Residents must be the gatekeepers for safe, high quality care–a sentinel on watch for the many unsafe conditions they might encounter while trying to provide optimal patient care, prepared to alert faculty and leadership to these unsafe conditions, and then work with their institutions to find solutions to remove risk from the patient experience. The analogy Dr. Leach used was the canary in the coal mine, taking on the role of guardian and protecting others from harm before it was too late. I loved this “moral agent” concept. It is so simple, yet so important in the quest for safer, higher quality, patient care. In academic medical centers, resident physicians spend more time in the hospital, have more direct contact with patients, and see many more unsafe conditions during days, evenings and weekends than most other caregivers, except possibly nurses. And they do it many times with little, if any, direct supervision. Resident physicians can be those sentinels and serve as excellent change agents for safer care.

We need more conferences like CIR’s QIIQ focused on our next generation of caregivers.  Please help spread the word about the conference. Below is some additional background information with the links to register. The third link is the conference brochure which has additional details.  We appreciate the support and as always, thank you!!

Background Info:
The one-day conference on How to be a Lead Agent of Change will be held Saturday, April 26th in New York City. Given the importance of the patient experience and the desire for more patient-centered care, the Committee of Interns and Residents conference is meant to empower medical residents to develop and execute high-value care projects in their hospitals and health systems, and better equip them with the competencies they need to work in a rapidly changing delivery system.

To register for this conference, please click here. There will also be a webcast, and people can sign up for that here. The agenda and conference brochure can be found here (this includes logistics on location and timing, as well as goals for the day and additional contact information). Please feel free to share this information, as well as the links to register, with your organization and networks.

*CIR has also been tweeting about the conference with the #QIIQ hashtag. Here is a sample tweet you are more than welcome to share with your followers: What’s your #QIIQ? Join @cirseiu & @EinsteinMed in NYC on 4/26 for the next #QIIQ conference. Register now! bit.ly/qiiq426


New Website for Resident Physician Education @CIRSEIU

Dr. David Leach, the former CEO of the Accreditation Council for Graduate Medical Education (ACGME), once wrote that the most important role a Resident Physician has is that of being the “moral agent” for their patients. They have the responsibility of speaking up when harm is near. I love this “moral agent” concept…it is so simple, yet so critically important in the quest for safer, higher quality, patient care. (See ETY, Canary in a Coalmine).

CIRSEIU_Residents_TrainingIn academic medical centers, Resident Physicians spend more time in our hospitals, have more direct contact with our patients, and see many more unsafe conditions and near misses than most caregivers. I hope all residents will be that moral agent – the “sentinel on watch” – for your patients. Report all near misses and unsafe conditions you experience to those in charge. Then help make a difference by working with your leadership to find solutions to those problems.

Today, the Committee of Interns and Residents (CIR, @CIRSEIU) will launch a new educational website for resident physicians (www.QIGateway.org) focused on quality and safety. The QIGateway portal is the first platform of its kind that is focused on patient safety and quality improvement by, and for, medical residents.

I encourage all resident physicians to visit this site, appreciate the growing body of quality and safety work being done by resident physicians across the country, and share your own quality and safety projects with others so that together we can continue to reduce risk and make care safer for all our patients

Through this exciting new educational website, the premise “Educate the Young” now aligns with “Inspire the Young”.  More and more resident physicians are becoming leaders and change agents in quality and safety – being the patient’s “moral agent” that Dr. Leach called for while helping make a difference at their home institutions. It is a brighter day for safe, high quality care at our academic medical centers thanks to the new QIGateway portal.


The Canary in the Coal Mine…Resident Physicians As Moral Agents

David Leach MD, the former CEO of the Accreditation Council for Graduate Medical Education (ACGME), always had a knack for seeing things a little differently. His unique insight provided a new perspective on resident education, leadership, or just life in general. In one of his annual ACGME talks, he discussed how having the courage to pick up the phone and call anyone — even someone at such a high level that they might never take your call — could turn out unexpected and positive results. He shared how he had learned through the years that many people at high levels will take your call simply because they are as passionate about the very topic you are reaching out to them about. This seemingly small, but important, insight has helped me throughout my career, and as such, I have continued to follow his work.

Canary in CageA number of years ago, I read a medical education book in which Dr. Leach had written a chapter on Professionalism. He covered what he felt was the most important role of the graduate resident physician – that of being the “moral agent” for their patients. He discussed how residents must be the gatekeepers for safe, high quality care –  a sentinel on watch for the many unsafe conditions they might encounter while trying to provide optimal patient care, prepared to alert faculty and leadership to these unsafe conditions, and then work with their institutions to find solutions to remove risk from the patient experience. The analogy Dr. Leach used was the canary in the coal mine – taking on the role of guardian and protecting others from harm before it is too late. I loved this “moral agent” concept. It was so simple, yet so important in the quest for safer, higher quality, patient care. In academic medical centers, resident physicians spend more time in the hospital, have more direct contact with patients, and see many more unsafe conditions during days, evenings and weekends than most caregivers — except possibly nursing.

As an extension of this “moral agent” concept, I was excited to see the new ACGME program requirements in response to the 2008 IOM report highlighting problems in graduate medical education associated with duty hours, supervision and patient safety. As a component of the new accreditation process, the ACGME has established the CLER (Clinical Learning Environment Review) program to assess the graduate medical education (GME) learning environment of each sponsoring institution and its participating sites. One key focus of the CLER program is the requirement that resident physicians now need to be submitting near miss and unsafe condition reports through their hospital’s occurrence reporting system – exactly what Dr. Leach was proposing many years ago when he brought forth the “moral agent” concept. The over-arching focus of CLER however will be the emphasis on the responsibility of the sponsoring institution for the quality and safety of the environment for learning and patient care, a key dimension of the 2011 ACGME Common Program Requirements. Note the emphasis and accountability is now on the sponsoring institution, as well as the residency program directors. The CLER program’s ultimate goal is to move from a major targeted focus on duty hours, to that of a broader focus on the GME learning environment and how it can deliver both high-quality physicians and the higher quality and safer patient care to the healthcare system as a whole.

With CMS, HRSA and others investing close to $9 billion dollars annually in graduate medical education, the day has now come for greater accountability in graduate medical education around safety and quality. Imagine what would happen if academic medical centers were “reimbursed” for their graduate medical education the same way hospitals are now being reimbursed for patient care with penalties for lapses in safety and quality education, similar to readmission or infection rates.  A reimbursement model based on Value-Based Education and HCAHPS for graduate medical education…where organizations like Consumer’s Union, Healthgrades and Leapfrog would publish annual “grades” for GME quality and safety programs across the country. That would surely raise the stakes, get institutional leadership’s attention, and change the graduate medical education landscape. Is that type of educational “transparency” heading our way in the not-too-distant future?