Such a rewarding, wonderful program and so grateful to still be part of it with such dedicated professionals @GNYHA and @UnitedHospFund Clinical Quality Fellowship Program.
Hillary Jalon's tweet is an appropriate coda to the culminating dinner for the 28 physicians and nurses who just completed the ninth class of the intensive Clinical Quality Fellowship Program (CQFP)—15 months of retreats, webinars, and individual mentoring focused on improving quality of care. Ms. Jalon, associate executive director for quality and performance improvement at NYC Health + Hospitals, and UHF's former CQFP director and director of quality improvement, joined fellow faculty members and alumni for this milestone dinner, held April 19 at UHF. The program is a joint project of UHF and Greater New York Hospital Association.
The 2017-18 class—19 physicians and 9 nurses—brings to 178 the total number of CQFP graduates since the program started in 2009. Many of the earlier alumni have advanced to top leadership positions in their institutions' quality improvement efforts, bolstered by the program's unique focus on teaching both techniques to improve patient care and leadership skills, a combination that empowers Fellows to be quality and safety champions.
“CQFP provides a progressive curriculum to balance the fundamental aspects of quality improvement with real-world strategies to apply in the challenging health care environment,” said Rohit Bhalla, MD, MPH, chair of the program and vice president and chief quality officer of Stamford Health. “This training is all the more important as the American health care delivery system evolves under health reform.”
Also attending the dinner were members of the current class, who will finish the program a year from now. They have much to look forward to—in a survey of past Fellows, they reported significant advances in their quality improvement skills, and 56 percent were promoted after they finished the program. “Our goal is for Fellows to use their new skills to assume leadership roles and responsibilities in their organizations, and improve health care quality throughout the region,” UHF President Anthony Shih, MD, MPH, told the meeting.
The centerpiece of the CQFP training is a capstone quality improvement project developed and led by each Fellow. At the dinner, graduates shared their experiences and discussed their projects and learnings with alumni and faculty.
Four of the fellows from the graduating class presented their work:
Jean Hsieh, MD, MS-HPEd, Associate Professor, Medical Progressive Care Unit Director and Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai
Discussion of quality and safety issues can be overlooked in busy hospitals. Dr. Hsieh focused on standardizing the discussion of quality during rounds in the Medical Progressive Care Unit at Mount Sinai, a 10-bed unit for patients with complex medical needs. She developed a checklist of evidence-based quality topics and found that the checklist, combined with nurse-driven prompting of quality discussions during rounds, did increase conversations about quality and safety issues.
Paul Huang, MD, Associate Director of Hospitalists, Stamford Health
Alcohol withdrawal syndrome is common among hospital inpatients, and Dr. Huang worked with a team to develop a standardized treatment protocol for patients in a step-down unit with alcohol withdrawal symptoms. He reported improvements in several outcomes measures, such as length of stay and benzodiazepine usage. Dr. Huang hopes to eventually spread the protocol to all medical-surgical floors.
Kathleen Asas, MD, MPH, FAAP, Pediatric Hospitalist, Division Director, Saint Barnabas Health Care System
Dr. Asas developed a checklist to improve the pediatric discharge process, recognizing that patients often experience adverse events and preventable errors during the transition. She worked to create a shared understanding of the discharge planning process by the medical team, built consensus on the timing of discharges, and improved the workflow, coming close to her goal of increasing to 30 percent the discharging of patients before noon as a result. Dr. Asas plans to build on this work to continue improving communication with families and staff and to integrate the practice more broadly.
David Koterwas, MS, NP, Nurse Practitioner, NYC Health + Hospitals/Bellevue
Headaches comprise 2-3 percent of Emergency Department visits nationwide and can be symptomatic of a broad range of diagnoses, from life-threatening to benign. Mr. Koterwas focused on using a triage algorithm to improve risk assignment of ED patients with non-traumatic acute headache. Collecting data and engaging staff proved to be challenging in the busy ED, but he will continue to work with leadership on implementing the algorithm and other opportunities to train staff on evaluating and managing non-traumatic headaches, with the aim of decreasing overutilization of CT scans.
Sharing the successes and continuing challenges of their capstones is an integral part of the CQFP experience, and new graduates and alumni alike agreed that continuing that process is an important next step. Alumni and faculty can continue to share their experiences and ideas through an online CQFP community on LinkedIn.
For photos of the 2017-18 culminating event, go to UHF's Facebook page.