1 systems based practice (sbp) dempsey springfield, md associate director for partners gme
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Systems Based Practice Systems Based Practice (SBP) (SBP)
Dempsey Springfield, MDDempsey Springfield, MD
Associate Director for Partners Associate Director for Partners GMEGME
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Conflicts of InterestConflicts of Interest• Member of Orthopaedic Dept. at MGHMember of Orthopaedic Dept. at MGH
• Associate Director for Partners GMEAssociate Director for Partners GME
• Deputy Editor for Journal of Bone and Deputy Editor for Journal of Bone and Joint SurgeryJoint Surgery
• No financial interest in products related to No financial interest in products related to Systems-based Practice.Systems-based Practice.
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TeachTeach
EvaluateEvaluate
Declare Declare competent.competent.
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Competency Based EducationCompetency Based Education
• Competency-based education focuses Competency-based education focuses on learner on learner performanceperformance in reaching in reaching specific specific objectivesobjectives..
• Not Not couldcould they have learned but they have learned but diddid they learn.they learn.
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Goals & ObjectivesGoals & Objectives• Goals are broad; objectives are narrow.Goals are broad; objectives are narrow.•
Goals are general intentions; objectives are precise.Goals are general intentions; objectives are precise.
• Goals are intangible; objectives are tangible.Goals are intangible; objectives are tangible.•
Goals are abstract; objectives are concrete.Goals are abstract; objectives are concrete.
• Goals can't be validated as is; objectives can be Goals can't be validated as is; objectives can be validated. validated.
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GoalGoal is to develop a is to develop a competent runner.competent runner.
ObjectiveObjective is to run 5-6 miles 4 is to run 5-6 miles 4 days per week and sprints 2 days per week and sprints 2 days per week for the 6 months days per week for the 6 months prior to the race.prior to the race.
Evaluation:Evaluation: Did they improve Did they improve performance? Did they stick to the performance? Did they stick to the training schedule? training schedule?
Feedback:Feedback: You need to pick up your You need to pick up your pace on long runs. Your sprint days pace on long runs. Your sprint days are perfect. Don’t forget to lift weights.are perfect. Don’t forget to lift weights.
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Systems Based PracticeSystems Based Practice• Residents should be evaluated against Residents should be evaluated against
agreed upon standards.agreed upon standards.
• GME office recommends that residents GME office recommends that residents be judged by how well they meet the be judged by how well they meet the Program’s standards.Program’s standards.
• Faculty should discuss criteria for Faculty should discuss criteria for evaluating residents.evaluating residents.
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Change in requirements.Change in requirements.
No longer a lone practitioner.No longer a lone practitioner.
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It’s a team sport.It’s a team sport.
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Systems Based PracticeSystems Based Practice
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Systems Based PracticeSystems Based Practice
• The whole has one or more defining functions. The whole has one or more defining functions.
• Each part can affect the behavior or properties of the Each part can affect the behavior or properties of the whole. whole.
• Each part is necessary but alone is insufficient to carry Each part is necessary but alone is insufficient to carry out the defining function of the whole. out the defining function of the whole.
• Behavior and properties of one part of the system Behavior and properties of one part of the system depend on the behavior and properties of at least one depend on the behavior and properties of at least one other part of the system. other part of the system.
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Systems Based PracticeSystems Based Practice• WHO’ s “High 5”WHO’ s “High 5”• 1. Concentrated injectable meds.1. Concentrated injectable meds.• 2. Med accuracy at transitions of care.2. Med accuracy at transitions of care.• 3. Communications during handovers.3. Communications during handovers.• 4. Improving hand hygiene.4. Improving hand hygiene.• 5. Correct site for procedures.5. Correct site for procedures.
• Cost is next.Cost is next.
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Best/faster runners in the world but they dropped the Best/faster runners in the world but they dropped the baton so their speed doesn’t matter.baton so their speed doesn’t matter.
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Systems Based PracticeSystems Based Practice• Residents must Residents must
demonstrate an demonstrate an awareness of and awareness of and responsiveness to the responsiveness to the larger context and system larger context and system of health care and the of health care and the ability to effectively call ability to effectively call on system resources to on system resources to provide care that is of provide care that is of optimal value. optimal value.
• Residents are expected Residents are expected to: to:
1.1. KnowKnow how types of medical how types of medical practice and delivery systems practice and delivery systems differ from one another, differ from one another, including methods of controlling including methods of controlling health care costs and allocating health care costs and allocating resourcesresources
2.2. PracticePractice cost effective health cost effective health care and resource allocation that care and resource allocation that do not compromise quality of do not compromise quality of carecare
3.3. AdvocateAdvocate for quality patient care for quality patient care and assist patients in dealing and assist patients in dealing with system complexitieswith system complexities
4.4. PartnerPartner with health care with health care managers and health care managers and health care providers to assess, coordinateproviders to assess, coordinate
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Systems Based PracticeSystems Based Practice• Describe the learning activity(ies) through which Describe the learning activity(ies) through which
residents achieve competence in the elements of residents achieve competence in the elements of systems-based practice: work effectively in various systems-based practice: work effectively in various health care delivery settings and systems, coordinate health care delivery settings and systems, coordinate patient care within the health care system; incorporate patient care within the health care system; incorporate considerations of cost-containment and risk-benefit considerations of cost-containment and risk-benefit analysis in patient care; advocate for quality patient care analysis in patient care; advocate for quality patient care and optimal patient care systems; and work in and optimal patient care systems; and work in interprofessional teams to enhance patient safety and interprofessional teams to enhance patient safety and care quality.care quality.
• Limit your response to 400 words. Limit your response to 400 words. PIF languagePIF language
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Examples of Learning Activities:Examples of Learning Activities:• Didactic LecturesDidactic Lectures,,• Assigned ReadingAssigned Reading, • SeminarsSeminars, , • self-directed learning module, • Conferences (M&M)Conferences (M&M),,• Small Group DiscussionsSmall Group Discussions,,• WorkshopsWorkshops, , • Online ModulesOnline Modules, , • journal club, journal club, • project, project, • Case DiscussionsCase Discussions, , • one-on-one mentoring
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Systems Based PracticeSystems Based Practice• Describe an activity that fulfills the Describe an activity that fulfills the
requirement for experiential learning in requirement for experiential learning in identifying system errors.identifying system errors.
• Limit your response to 400 words.Limit your response to 400 words.
PIF languagePIF language
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Examples of activities …Examples of activities …
• Root cause analysis.Root cause analysis.
• Improvement in care based upon a Improvement in care based upon a systems change.systems change.
• Analysis/improvement of transitions of Analysis/improvement of transitions of care.care.
• Analysis/change in the use of referrals or Analysis/change in the use of referrals or of diagnostic test.of diagnostic test.
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Advocate for patient careAdvocate for patient care
• Didactic presentations on insurance Didactic presentations on insurance benefits.benefits.
• Advise patients about necessary Advise patients about necessary insurance benefits.insurance benefits.
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Partner with othersPartner with others• Work with 3Work with 3rdrd party payers. party payers.
• Know how the hospital is paid.Know how the hospital is paid.
• Teach patients about their insurance Teach patients about their insurance benefits.benefits.
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Systems Based PracticeSystems Based Practice
• Goal:Goal:
• To be aware of and responsive to the larger To be aware of and responsive to the larger context and system of health care and the ability context and system of health care and the ability to effectively call on system resources to provide to effectively call on system resources to provide care that is of optimal value.care that is of optimal value.
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Systems Based PracticeSystems Based Practice
• Objectives:Objectives:
• Residents will consult services effectively.Residents will consult services effectively.• Residents will participate in multidisciplinary Residents will participate in multidisciplinary
care.care.• Residents will understand the patient’s Residents will understand the patient’s
insurance.insurance.• Residents will know their “place” in the Residents will know their “place” in the
system(s).system(s).• Residents will practice efficient medical care.Residents will practice efficient medical care.
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Systems Based PracticeSystems Based Practice• Faculty need “anchors.”
– Provide clear guidance.
• Feedback based on objectives.
• Evaluations based on objectives.
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Systems Based PracticeSystems Based Practice• Team player.Team player.
• Multidisciplinary rounds.Multidisciplinary rounds.
• Nurses evaluation of residents.Nurses evaluation of residents.
• Quality assessment improvements.Quality assessment improvements.– Look for ways to improve patient care by Look for ways to improve patient care by
changing a system.changing a system.
This slide and the next 2 are the 3 examples.
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Practice cost effective medicinePractice cost effective medicine
• Teach the cost of care.Teach the cost of care.
• Do audits of care.Do audits of care.
• Look for ways to reduce cost.Look for ways to reduce cost.
• Implement reduced costly care.Implement reduced costly care.
• Consider cost when prescribing.Consider cost when prescribing.
• Study means to reduce cost while Study means to reduce cost while maintaining quality.maintaining quality.
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Know about cost and allocating Know about cost and allocating resourcesresources
• Didactic presentations.Didactic presentations.
• Study cost of difference Rx’s.Study cost of difference Rx’s.
• Finds means to reduce LOS and/or reduce Finds means to reduce LOS and/or reduce readmissions.readmissions.
• Consider cost/benefit of diagnostic tests.Consider cost/benefit of diagnostic tests.
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Systems Based PracticeSystems Based Practice• 1. Documented multisystem care teams.1. Documented multisystem care teams.
• 2. Have residents involved in QA.2. Have residents involved in QA.
• 3. Have resident involved in systems 3. Have resident involved in systems improvements.improvements.
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Thank youThank you• Dempsey Springfield, MDDempsey Springfield, MD
• Associate Director Partners GMEAssociate Director Partners GME