Put Residents at the Center of Patient Safety With Housestaff Quality Councils

Rolling out new policies and procedures is a challenge for hospital leaders. Effective communication is critical to ensuring healthcare staff comply with new patient care protocols. House staff are an important audience to reach because they're typically providing the bulk of patient care in many hospitals. Without their buy in and support, many initiatives fall short.

New York-Presbyterian Hospital's Housestaff Quality Council (HQC) provides hospitals with a model for engaging residents in patient safety and quality initiatives and policymaking.

The HQC is a win-win
The HQC facilitates two-way communication between residents and the rest of the hospital—administrators, hospital and patient safety, nursing, etc.—regarding quality and patient safety issues and initiatives, says Peter Fleischut, MD, anesthesiology resident at New York-Presbyterian and cocreator of the HQC.

"The mission of the HQC is to engage house staff in policy and decision-making processes to further improve quality and patient safety within the institution," Fleischut says.

The council is run by residents, but other members include:

• Resident representatives from each department
• Faculty advisor
• Liaison from the office of quality and patient safety
• Office of the vice president representative
• Representatives from infection control, nursing, epidemiology, and pharmacy

With an HQC, institutions can more easily:

Identify opportunities to improve frontline patient care. Although hospital administrators can identify quality initiatives derived from data, such as hand hygiene compliance, they often do not have insight into what's happening on the front lines of patient care.

Residents have this knowledge and can identify system issues that can be improved to prevent errors, says Adam S. Evans, MD, MBA, anesthesiology resident at New York-Presbyterian and cocreator of the HQC.

However, residents often do not have a venue for making their observations known and they are not invited to help develop solutions. During HQC meetings, residents have the administration's ear, and they can partner with them and other hospital departments to develop solutions.

Increase compliance with new policies. All too often, decision-makers develop patient care policies or processes without resident input or an effective way to spread the word. Ultimately, they end up with low compliance rates.

"House staff need to be at the table and they need to be involved in the decision-making process," says Gregory E. Kerr, MD, MBA, associate professor in the Department of Anesthesiology and faculty advisor for the HQC at New York-Presbyterian.

By engaging residents and asking them for solutions, the hospital gets their perspective on important patient safety issues, and creates buy-in with trainees, Kerr says.

If trainees participate in the policymaking process and support it, they're also more likely to enforce it with their peers, Evans says.

Get the word out. "The hospital was having a hard time communicating patient safety and quality information to residents. They didn't have an outlet, and they weren't sure about the best way residents learn, so the HQC is also charged with communication," Evans explains.

Resident representatives to the HQC take information back to their programs.

"Every department communicates differently," Evans says. "I know how residents in my program like to have information delivered and what they will respond to, so we encourage residents to take the information back in the manner that will be best received."

For major, broad-sweeping patient safety programs, the HQC raises awareness for all healthcare providers with banners, e-mails, posters, dissemination of data, and an HQC newsletter, Fleischut says.

HQC structure and function
The HQC addresses patient safety and quality on two levels. First, the HQC adopts one or two large-scale initiatives each year that affects patient care throughout much of the hospital. Second, it is a forum where people working on specific quality improvement projects can come for resident input.

HQC leadership works with hospital administration, quality officers, and residents to identify an area for improvement for larger projects. At New York-Presbyterian, the HQC's large-scale projects have included developing an electronic solution that increased medication reconciliation compliance rates from 46% to 95% in one month. Another campaign to reduce Clostridium difficile rates led to a 50% reduction in most of the major units, Evans says.

Smaller quality projects are presented and discussed during the HQC's monthly meetings. For example, a vascular surgeon developing a new order set for pulmonary embolisms came to the HQC, presented the tool, and requested the residents' opinion on whether the tool was too complex, how he should advertise it, and whether it could be improved.

The HQC's input has been so valuable that there is a six-month wait to present at the meeting. "It's such a hot commodity within the institution," Kerr says.

The HQC concept is a model that can be easily replicated in other institutions. Kerr, Evans, and Fleischut are already working with other teaching hospitals around the country to implement HQCs in their institutions.