National Initiative I

Since the National Initiative focuses upon GME as a driver for improved quality and safety, Alliance leaders realized that collaboration with key education and clinical stakeholders was needed. Paul Gardent, MBA, Instructor in Community and Family Medicine at Dartmouth Medical School and Chairman, Committee on Innovation in the Learning Environment (CILE) for the Accreditation Council for Graduate Medical Education (ACGME), was invited to participate and was a most valuable resource in linking the goals of the National Initiative I to the ACGME competencies.

On the clinical side, the Institute for Healthcare Improvement (IHI) was quickly identified as an influential leader in new process improvements. IHI Senior Vice President Jim Conway was invited to participate and provided key leadership in linking the National Initiative to IHI’s 5 Million Lives Campaign. The National Initiative I used the 5 Million Lives Campaign as the backbone for linking residents to improvements in patient care. By doing so, the residency programs, the hospital administration and the hospital boards of directors were aligned in a mutual effort to improve patient care. This approach was markedly different from previous residency quality improvement initiatives that had often been peripheral and disconnected with the priorities of the hospital leadership.

At the second meeting of the National Initiative I and four months into the 18-month project, the following three areas of focus were identified: Hand-Offs (EMR and shift-to-shift hand-offs), Infection Control (reducing central line infection and MRSA) and Transitions of Care (medication reconciliation and CHF). The 34 participants were assigned to one of these three “work groups” based upon their institution’s need and interest. Participants were assisted with the design and scope of their institution’s quality improvement (QI) project, including identified milestones and project goals. These on-site exercises provided much-needed structure to the projects. Even though each institution’s project was slightly different based upon their set of circumstances, the framework required ensured key commonalities and allowed participants to report and track their specific progress.

AIAMC National Initiative I participants were brought together five times over an 18-month period. Each meeting was two days in length, and four of the five meetings were held in conjunction with other national meetings in an effort to reduce travel expenses of member institutions. They were professionally facilitated and provided participants with the opportunity to share successes and barriers, network with colleagues and energize their commitment to the National Initiative. These meetings resulted in increased enthusiasm and motivated participants to return to their home institutions and successfully complete their projects.

In addition to the on-site meetings, National Initiative I members participated in monthly teleconference calls. Calls were held for each of the three work groups and served to keep participants on track with their QI projects. Attendance for these calls was closely monitored, and any member missing more than one call was contacted by a National Initiative steering committee member to ensure their continued commitment. These monthly calls provided the glue and continuity necessary for such a large-scale project.

Initial data on the impact of integrating GME into patient safety and quality improvement initiatives was presented at the fourth meeting in March 2008. At the fifth and final meeting, it was reported that a dozen manuscripts have been written and await publication. Click here to view and/or download the National Initiative Phase I White Paper.

• National Initiative I Mission, Vision, and Goals
• National Initiative I Leadership
• National Initiative I Public Resources