Incentive Program Supports Educational, Patient Care Goals for Resident Physicians
In an effort to improve and reinforce residents' commitment to patient satisfaction, quality of care, and safety, the University of California, San Francisco (UCSF) graduate medical education (GME) program and its major affiliate institution, UCSF Medical Center, has established a goal-based incentive program that allows trainees to earn up to an extra $1,200 per year.
"The incentive program highlights process measures and patient outcomes that are central clinical goals for the institution and our GME program," says Robert Baron, MD, MS, associate dean of graduate and continuing medical education at UCSF. Baron and administrators from UCSF Medical Center develop three goals, and residents work throughout the academic year to meet them.
Each goal is worth $400, and residents' performance is measured as a group, not individually. House staff members must collectively meet all three goals to receive the full incentive. If they meet only two goals, each trainee will receive $800, Baron explains. For instance, the three goals for the 2008&.dash;2009 academic year were:
- Patient satisfaction. Maintain an annual 71st percentile ranking compared to national peers on the Press Ganey patient satisfaction survey "likelihood of recommending" question.
- Patient quality and safety. Achieve and maintain an average of 95% compliance with the "do physician orders have all required elements" question on UCSF Medical Center compliance audits.
- Pain management. Maintain an annual 75th percentile ranking compared to national peers on the Press Ganey inpatient satisfaction survey "how well your pain was controlled" question.
UCSF Medical Center funds the program so only those who work 12 weeks or more at UCSF Medical Center are eligible. About 900 residents and fellows qualify for the incentive, Baron says.
When selecting goals, Baron and UCSF Medical Center leadership carefully aligned UCSF Medical Center's patient care initiatives with UCSF's educational program. "If it was not lined up carefully with our educational endeavors, it would be more of a service-based incentive rather than an educational incentive," Baron says.
Fusing the two was not a stretch. Almost all quality and patient satisfaction initiatives provide learning opportunities for residents.
For example, after a CMS site visit, UCSF Medical Center wanted to increase compliance with physician order writing. This has now become goal number two, and residency programs incorporate lectures on the topic into their curriculum.
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