Designing for the Future: Quality and Safety Education at US Teaching Hospitals.

Abstract

Teaching hospitals in the United States are under unprecedented pressure to demonstrate value.1,2 Coupled with national policy trends and demand from consumers, there has been an increased focus on systems-based quality improvement and patient safety. Alongside this increased scrutiny, in 2012 the Accreditation Council for Graduate Medical Education (ACGME) outlined its new accreditation system, urging enhanced competence in systems-based practice for the next generation of physicians.3 One component of the new system is the Clinical Learning Environment Review (CLER) program, which includes institutional site visits to assess resident participation in 6 focus areas: patient safety, quality improvement, care transitions, supervision, duty hours, and professionalism. Early findings from the first year4 of the CLER site visits “indicate a generalized lack of resident engagement in a ‘systems-based practice’ of medicine in the clinical environments in which they learn and provide clinical care.”5 During the development of the CLER program, the Institute for Healthcare Improvement, in collaboration with the ACGME, identified opportunities for improvement in quality and safety and systems-based education within graduate medical education (GME) programs using literature reviews, key informant interviews, reviews of GME curricula, and site visits. Based on that experience, we offer a perspective on current challenges and several principles to guide institutions toward achieving ACGME's evolving standards for systems-based practice.