March 11, 2019
SUMMARY: We review two more e-posters from the ASA practice management meeting in Las Vegas: a leadership training program developed by anesthesiologists for anesthesia residents and faculty, and an anonymous perioperative incident reporting system to improve patient safety, quality and resident education.
This week’s eAlert continues with additional reviews of some of the more thought-provoking e-posters from the ASA’s PRACTICE MANAGEMENT™ 2019. The posters summarized here, like all of the other posters at this meeting, are based on initiatives at one institution. As such, the findings will not necessarily apply to other practices. However, the ideas and information here can be used as a springboard for possible practice improvement initiatives within your own facilities.
Anesthesiologist leadership training. To address the shortage of leadership development opportunities in medicine, the anesthesiology department at the University of Kansas Medical Center developed its own program for residents and anesthesia faculty called Leadership Education and Development (LEAD). The 18-month to two-year program is structured around monthly low-key, off-campus forums led by experts on a wide range of important leadership topics, including emotional intelligence, conflict resolution, billing for anesthesiology services, team-building, risk management, legislative issues and advocacy, strategic planning, operating room management, financial statements and more.
Topics are covered in lectures, interactive discussions and/or small group breakouts, with flexibility to accommodate department members’ busy schedules. Participants complete an assessment survey after each presentation and periodically throughout the year, noting specific examples of how the program has contributed to their success as leaders and allowed them to acquire new skills. Participants also receive a leadership and personality assessment to gain insight into their competencies and leadership style, and have the option to earn a certificate of completion, which involves completing an individual project, such as serving on a university or hospital planning or advisory committee, or spearheading a project with a local or national medical society.
The program also weaves presentations on leadership topics into regularly scheduled departmental meetings. These presentations are structured as short talks similar to the popular TED (technology, entertainment, design) series to maximize the efficient delivery of substantive content. All LEAD sessions are recorded and posted on a departmental website.
The program has become a departmental priority “because leadership development helps improve all aspects of perioperative care,” note Timothy Krause, DO, program sponsor/champion, and his colleagues. As the program’s website states, “there is a critical need for physicians to function effectively in complex organizations as advisors and leaders.” LEAD strives to fill the gap where medical school training leaves off.
Anonymous reporting. When it comes to identifying and discussing near-miss and adverse events in the perioperative space, morbidity and mortality conferences can be too narrow and hospital incident reporting systems (IRS) are rarely used by physicians. Research has shown that physicians generate fewer than two percent of incident reports through these traditional systems.
Anesthesiologists at Stanford University developed an anonymous reporting system for significant perioperative events to enhance resident education, improve patient safety and identify issues requiring quality improvement. Events are gathered, analyzed and disseminated to residents and anesthesia department members via a newly formed House Staff Quality & Education Committee.
“While sharing and discussing reported events throughout our department can provide effective and efficient changes, we also recognize that there are inherent risks with such activities that need to be accounted for,” said lead author Jeffrey Skanchy, MD, and his anesthesia colleagues. “Such procedures need to balance patient privacy and medicolegal risks with the benefit and utility of improving patient safety and resident education.”
Reports are entered into a password protected website and collected in a protected database to ensure that all residents are able to submit reports anonymously. Close collaboration with risk management and the privacy office ensures reports are HIPAA compliant and consistent with the medical center’s policies.
The department began with a survey of anesthesia residents, which revealed that, similar to findings at other institutions, only 43 percent had ever used the IRS and that less than five percent had submitted more than one event. Barriers to reporting included problems accessing a confusing and cumbersome IRS, cultural issues such as fear of exposure and retaliation (36 percent) and frustration with a lack of follow up on reports (57 percent).
The department then had several meetings with legal counsel, risk management, privacy, internal hospital committees and the graduate medical education committee to develop a perioperative incident reporting system.
A peer review committee (the House Staff Quality & Education Committee) protects findings from any forced disclosure. Anesthesia residents form a key element of the peer review committee, which identifies events requiring further action, intervention and education and reports to the department’s Medical Education and Quality, Effectiveness and Patient Safety Committees.
Findings are disseminated to residents via quarterly newsletters, quarterly M&M meetings with each residency class and quarterly department dinners.
“When residents are afforded safe environments and opportunities to share perioperative incidents and associated learning points,” Dr. Skanchy and his colleagues concluded, “they bolster each other’s educational experience, create a social interface to boost morale, and improve patient care by avoiding future adverse patient outcomes.”
All of the e-posters from PRACTICE MANAGEMENT™ 2019 can be seen here.