27 Jan Teaching Value- Arizona
By Cheryl O’Malley, MD, FACP and Steven R. Brown, MD, FAAFP
A little friendly competition is a good thing. We’ve seen it work in our residency programs. That’s why we answered the challenge of the “Teaching Value and Choosing Wisely Competition” with a competition of our own.
Unfortunately, it’s not hard to find the waste and low value care in most hospitals. We reasoned that the best ideas to promote and teach high value care would come right from our own residents and fellows. Our hospital, Banner Good Samaritan Medical Center, is among the largest teaching hospitals in the Southwest and a major teaching affiliate of the University of Arizona College of Medicine – Phoenix, where we are both faculty. Banner Health is among the more innovative health systems in the country and has jumped in with both feet to the “high-value” movement. Banner has incorporated high-value care into its major strategic objectives and is one of Medicare’s Pioneer Accountable Care Organizations. It is not enough to just provide more care. We have to provide high-value care: better quality at less cost. Our contest was designed to educate house staff in high value care, improve patient care, develop future leaders in healthcare, engage house staff in quality improvement activities, and disseminate findings to improve care throughout the system and beyond.
We challenged residents and fellows in our graduate medical education programs to enter our “High Value Care” contest. Three project ideas would win $2,500 each and the opportunity to design and implement their “high value” idea with an interdisciplinary team in our hospital. The cash prize was donated by the medical staff. The entries were limited to 500 words and were judged based on: the impact on house staff education, the impact on patient outcomes, and the feasibility, scalability and alignment with the Choosing Wisely® campaign and/or Banner Health strategic objectives.
We received a remarkable 46 entries from residents and fellows in 11 programs. Our first-round judges, engaged faculty from seven of our residencies and fellowships, selected eleven finalists. Our final judges were high-profile leaders from throughout the hospital and system including the system Chief Medical Officer, the hospital Chief Executive Officer, and the Chief Nursing Officer. We thought including our system leaders as judges would be a great way to engage these leaders with our training programs and innovative efforts to improve care.
The final projects were as wide-ranging in their approach as they were high quality. The final projects included ideas to decrease admissions in cirrhosis, address end-of-life decision making, minimize imaging for duodenal tubes in the ICU, and increase the use of probiotics, to name a few.
The winning ideas, from residents in our orthopedic, family medicine, and internal medicine programs were:
- Attempted reduction of unnecessary diagnostic testing by utilization of cost transparency
- An evidence-based approach to reducing the incidence of catheter-associated urinary tract infections
- Implementation of a hospital-wide system to increase the appropriate use of cardiac stress testing
Now the hard work really begins for these winners. They have already assembled their multi-disciplinary teams and received guidance from leaders in our system. These three will present their high value project final results in May 2014 at our “Graduate Medical Education Quality and Safety Day” with a chance to win another $2,500.
Our “High Value Care” challenge at Banner Good Samaritan is off to a great start. We’ve had great support from hospital and system leadership, the program directors and faculty, and the medical staff. Our residents and fellows have great ideas on how to provide high value care and have shown their dedication to this important effort. We look forward to seeing the impact of these innovative ideas across the system and to future years of our “High Value Care” contest.
Cheryl O’Malley, MD, FACP is Program Director, Internal Medicine at Banner Good Samaritan Medical Center, University of Arizona College of Medicine – Phoenix
Steven R. Brown, MD, FAAFP is Program Director, Family Medicine at Banner Good Samaritan Medical Center, University of Arizona College of Medicine – Phoenix