QI Success Depends on Front-Line Physicians

When Dr. Alexander Carbo joined the faculty at Beth Israel Deaconess Medical Center in Boston in 2001, straight out of his residency, he rushed to become a member of the department of medicine’s quality improvement committee. Little over a decade later, Dr. Carbo leads that committee. He has also helped continue the success of BIDMC’s Stoneman Patient Safety Rotation, which serves as a kind of patient safety boot camp for residents.

In an interview with Hospitalist News, Dr. Carbo discussed the importance of engaging front-line clinicians in quality improvement projects and why residents and staff need training on how to improve patient safety.

Question: You’ve said that engaging front-line providers is critical for quality improvement. Why?

Dr. Carbo: We have to have a culture of safety. The only way that we can actually make improvements is if somebody knows that improvements are needed. If people don’t call things out, there is no way to fix them. It’s key for people to be able to call things out and to do that in a way that is nonthreatening. We try to make it clear here, we’re not here to look at individuals. We’re not here to get anybody in trouble. We’re here to figure out if there’s either an adverse event with or without error or an error with or without an adverse event. What happened? And how can we prevent this from happening in the future. We just need to have people call things out. I think most of our folks do more than that, but that’s where you have to start. That is the key component. Once people call things out, the next step is actually having them try to solve the problem.

Question: You are the attending preceptor for the Stoneman Patient Safety Rotation at BIDMC. What are your residents exposed to during this rotation?

Dr. Carbo: This rotation was started a decade ago by Dr. Kenneth Sands, who is our senior vice president of healthcare quality, and organized by Dr. Anjala Tess, who is a hospitalist and one of my colleagues here. The two of them – and several others – started this rotation and we’ve now put through several hundred residents. It is a mandatory patient safety rotation for all BIDMC residents. They go through a didactic component, a root-cause analysis, and complete a group project.

In the didactic component, we give lectures on root-cause analysis and process improvement. And residents get a chance to go to high-level committee meetings within the hospital.

The second part is that each resident is given a live case to review and then present at the medical peer review committee, which I chair. It’s very interesting for them, because unlike most programs in which they only get to talk about a hypothetical case, they actually examine the cases that we review. We usually try to give the residents cases that focus on process, such as a delay in antibiotic administration.

They also do a group project. The last group worked on improving the death-reporting process. Another group is looking at telemetry use in the hospital.

Question: Why is it important to have this exposure during residency?

Dr. Carbo: It is so central to what we as physicians do. But it’s something that most of us were never explicitly taught in medical school. It’s interesting for me as a teacher, because it’s one of the few topics I can teach to a resident that’s 60% new material. If I were to teach them about cardiology or pneumonia care, I don’t think I could teach them as much new material as I can teach them in quality and safety. The nice thing about quality and safety is that it cuts across every single discipline. If I teach you about patient safety and quality improvement, regardless of what you do in your career, it is applicable.

Question: What about practicing clinicians. Are they getting enough training on how to improve patient safety?

Dr. Carbo: None of us have enough training on patient safety. Hospitalists should work locally within their community and talk to their patient safety officer or their boss to really identify something that’s important to them. They can partner with the nurses, or physicians, or pharmacists they work with. Try to start small and work from there. Not everyone needs to fix every quality improvement problem in their hospital all at once.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to [email protected]. Read previous columns at ehospitalistnews.com.

When Dr. Alexander Carbo joined the faculty at Beth Israel Deaconess Medical Center in Boston in 2001, straight out of his residency, he rushed to become a member of the department of medicine’s quality improvement committee. Little over a decade later, Dr. Carbo leads that committee. He has also helped continue the success of BIDMC’s Stoneman Patient Safety Rotation, which serves as a kind of patient safety boot camp for residents.

In an interview with Hospitalist News, Dr. Carbo discussed the importance of engaging front-line clinicians in quality improvement projects and why residents and staff need training on how to improve patient safety.

Question: You’ve said that engaging front-line providers is critical for quality improvement. Why?

Dr. Carbo: We have to have a culture of safety. The only way that we can actually make improvements is if somebody knows that improvements are needed. If people don’t call things out, there is no way to fix them. It’s key for people to be able to call things out and to do that in a way that is nonthreatening. We try to make it clear here, we’re not here to look at individuals. We’re not here to get anybody in trouble. We’re here to figure out if there’s either an adverse event with or without error or an error with or without an adverse event. What happened? And how can we prevent this from happening in the future. We just need to have people call things out. I think most of our folks do more than that, but that’s where you have to start. That is the key component. Once people call things out, the next step is actually having them try to solve the problem.

Question: You are the attending preceptor for the Stoneman Patient Safety Rotation at BIDMC. What are your residents exposed to during this rotation?

Dr. Carbo: This rotation was started a decade ago by Dr. Kenneth Sands, who is our senior vice president of healthcare quality, and organized by Dr. Anjala Tess, who is a hospitalist and one of my colleagues here. The two of them – and several others – started this rotation and we’ve now put through several hundred residents. It is a mandatory patient safety rotation for all BIDMC residents. They go through a didactic component, a root-cause analysis, and complete a group project.

In the didactic component, we give lectures on root-cause analysis and process improvement. And residents get a chance to go to high-level committee meetings within the hospital.

The second part is that each resident is given a live case to review and then present at the medical peer review committee, which I chair. It’s very interesting for them, because unlike most programs in which they only get to talk about a hypothetical case, they actually examine the cases that we review. We usually try to give the residents cases that focus on process, such as a delay in antibiotic administration.

They also do a group project. The last group worked on improving the death-reporting process. Another group is looking at telemetry use in the hospital.

Question: Why is it important to have this exposure during residency?

Dr. Carbo: It is so central to what we as physicians do. But it’s something that most of us were never explicitly taught in medical school. It’s interesting for me as a teacher, because it’s one of the few topics I can teach to a resident that’s 60% new material. If I were to teach them about cardiology or pneumonia care, I don’t think I could teach them as much new material as I can teach them in quality and safety. The nice thing about quality and safety is that it cuts across every single discipline. If I teach you about patient safety and quality improvement, regardless of what you do in your career, it is applicable.

Question: What about practicing clinicians. Are they getting enough training on how to improve patient safety?

Dr. Carbo: None of us have enough training on patient safety. Hospitalists should work locally within their community and talk to their patient safety officer or their boss to really identify something that’s important to them. They can partner with the nurses, or physicians, or pharmacists they work with. Try to start small and work from there. Not everyone needs to fix every quality improvement problem in their hospital all at once.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to [email protected]. Read previous columns at ehospitalistnews.com.

When Dr. Alexander Carbo joined the faculty at Beth Israel Deaconess Medical Center in Boston in 2001, straight out of his residency, he rushed to become a member of the department of medicine’s quality improvement committee. Little over a decade later, Dr. Carbo leads that committee. He has also helped continue the success of BIDMC’s Stoneman Patient Safety Rotation, which serves as a kind of patient safety boot camp for residents.

In an interview with Hospitalist News, Dr. Carbo discussed the importance of engaging front-line clinicians in quality improvement projects and why residents and staff need training on how to improve patient safety.

Question: You’ve said that engaging front-line providers is critical for quality improvement. Why?

Dr. Carbo: We have to have a culture of safety. The only way that we can actually make improvements is if somebody knows that improvements are needed. If people don’t call things out, there is no way to fix them. It’s key for people to be able to call things out and to do that in a way that is nonthreatening. We try to make it clear here, we’re not here to look at individuals. We’re not here to get anybody in trouble. We’re here to figure out if there’s either an adverse event with or without error or an error with or without an adverse event. What happened? And how can we prevent this from happening in the future. We just need to have people call things out. I think most of our folks do more than that, but that’s where you have to start. That is the key component. Once people call things out, the next step is actually having them try to solve the problem.

Question: You are the attending preceptor for the Stoneman Patient Safety Rotation at BIDMC. What are your residents exposed to during this rotation?

Dr. Carbo: This rotation was started a decade ago by Dr. Kenneth Sands, who is our senior vice president of healthcare quality, and organized by Dr. Anjala Tess, who is a hospitalist and one of my colleagues here. The two of them – and several others – started this rotation and we’ve now put through several hundred residents. It is a mandatory patient safety rotation for all BIDMC residents. They go through a didactic component, a root-cause analysis, and complete a group project.

In the didactic component, we give lectures on root-cause analysis and process improvement. And residents get a chance to go to high-level committee meetings within the hospital.

The second part is that each resident is given a live case to review and then present at the medical peer review committee, which I chair. It’s very interesting for them, because unlike most programs in which they only get to talk about a hypothetical case, they actually examine the cases that we review. We usually try to give the residents cases that focus on process, such as a delay in antibiotic administration.

They also do a group project. The last group worked on improving the death-reporting process. Another group is looking at telemetry use in the hospital.

Question: Why is it important to have this exposure during residency?

Dr. Carbo: It is so central to what we as physicians do. But it’s something that most of us were never explicitly taught in medical school. It’s interesting for me as a teacher, because it’s one of the few topics I can teach to a resident that’s 60% new material. If I were to teach them about cardiology or pneumonia care, I don’t think I could teach them as much new material as I can teach them in quality and safety. The nice thing about quality and safety is that it cuts across every single discipline. If I teach you about patient safety and quality improvement, regardless of what you do in your career, it is applicable.

Question: What about practicing clinicians. Are they getting enough training on how to improve patient safety?

Dr. Carbo: None of us have enough training on patient safety. Hospitalists should work locally within their community and talk to their patient safety officer or their boss to really identify something that’s important to them. They can partner with the nurses, or physicians, or pharmacists they work with. Try to start small and work from there. Not everyone needs to fix every quality improvement problem in their hospital all at once.

Take us to your leader. Nominate a hospitalist whose work inspires you. E-mail suggestions to [email protected]. Read previous columns at ehospitalistnews.com.