Both the public and our profession acknowledge that quality and safety efforts are falling short, and many hospitals and healthcare systems are seeking rapid improvements in patient care. Those of us in academic medicine realize that residents play an important role in patient care at teaching institutions; however, residents are generally not visible in safety and quality efforts. The AIAMC recognized that resident quality improvement efforts – shared across multiple programs and systems – had the potential to improve care much more quickly and effectively.
The Alliance of Independent Academic Medical Centers was founded in 1989 as a national network of large academic medical centers. Membership in the association is unique in that AIAMC members are affiliated with medical schools but are independent of medical school ownership or governance. Eighty-four major medical centers across the United States are members, representing more than 725 senior academic leaders across the United States.
In early 2007, the Alliance of Independent Academic Medical Centers (AIAMC) launched Improving Patient Care through GME: A National Initiative of Independent Academic Medical Centers. The National Initiative (NI) featured five meetings over the course of 18 months which served as touchstones for ongoing quality improvement in 19 AIAMC participating organizations. These meetings, as well as the monthly collaborative calls held in-between, provided structure, discussion and networking opportunities around specific quality improvement initiatives. As a result of these efforts, we developed initial findings that demonstrated the efficacy of integrating GME into patient safety and quality improvement initiatives. These findings were organized into a series of articles that were published in the December 2009 issue of Academic Medicine.
In 2009, we launched the National Initiative II and expanded participation to 35 AIAMC-member teaching hospitals from Seattle to Maine. Each participating hospital developed a quality improvement team led by a resident or faculty member. These teams met on-site four times and participated in monthly conference calls over an 18-month period. Quality improvement projects focused upon one of the following areas: Communication, Hand Offs, Infection Control, Readmissions and Transitions of Care. Results from NI II were published in a variety of publications, including the February 2011 issue of the AAMC Reporter, and in the May/June 2012 special supplement issue of the American Journal of Medical Quality.
NI III, launched in 2011 with 35 teams, built on the strengths of the first two phases of the AIAMC National Initiative, and moved beyond direct support of local quality improvement teams to the development of teaching leadership and changing organizational culture to support quality improvement initiatives. Graduate medical education and continuing medical education were emphasized as platforms for improving patient care. The focus of NI III was faculty/leadership development. Structurally, NI III engaged faculty members, program directors, residents, continuing education specialists and quality improvement leaders in a cohort model of learning. Quality improvement projects focused on one of the following: Comprehensive Faculty Development Program, Specific Faculty Development Program, Quality Improvement Faculty Development Program, Specific Quality Improvement Project, Hand-offs, and Resident Quality Councils. A writing team was convened for the purpose of publishing the collective work of National Initiative III.
NI IV: Achieving Mastery of CLER focused on navigating the ACGME’s new CLER program. The CLER program was designed to evaluate the level of institutional responsibility for the quality and safety of the learning and patient care environment, and NI IV provided teams the training and guidance necessary to a) identify strengths and weaknesses across the six focus areas, b) prioritize areas for improvement, c) outline, streamline and implement improvement strategies, and, d) significantly and measurably advance the institutional level of preparedness.
The overall structure of NI IV had three compliments: monthly teleconferences, monthly assignments, and four live meetings. Monthly team teleconference groups were structured by area (Patient Safety, Quality Improvement, Transitions of Care, Supervision, Fatigue Management, or Professionalism), with cross pollination and sharing of best practices across all six areas occurring at the on-site meetings. Institutions that had already experienced a CLER visit were spread throughout the teleconference groups so their experience reaches a wide audience. The AIAMC has developed a repository of critical information from institutions with CLER site visit experience (key learnings, surprises, ‘insider’ tips, etc.), which will be updated regularly and shared with all participants. On-site meeting sessions addressed, among other things: how to prepare for a visit and how to better engage the c-suite.
National Initiative V, launched in the summer of 2015 with 29 teams, will focus on navigating the disparities component of the ACGME’s Clinical Learning Environment program. Why health disparities? National Initiative IV (2013-15) focused on the ACGME’s Clinical Learning Environment Review (CLER). Our experience with that Initiative — coupled with the findings of the ACGME’s site visit teams over the past two years — has confirmed that institutions are not equipped to successfully meet the expectations for reducing health disparities as suggested by the ACGME, IOM and others. Health disparities in the United States are well documented, and despite the efforts of numerous organizations, stark inequities remain. Independent academic medical centers play a critical dual role in addressing this national problem because we train the future physician workforce and serve as key safety net providers for our local populations.