Background:
With increasing focus on healthcare value, both patients and providers have much to gain from enhancing how trainees learn to disburse a precious healthcare resource: time. However, efficiency is rarely an educational objective. Rather, it is assumed to be an asset inherent to the individual or acquired through passive experience. This forces trainees to rely on trial and error or informal advice from colleagues to improve how they use time in the clinical environment.
Purpose:
We developed and implemented a structured coaching model designed to increase awareness and practice of clinical efficiency among residents undertaking a month‐long hospital medicine rotation.
Description:
Residents can elect to spend a month rotating one‐on‐one with a hospital medicine physician at our academic medical center. Within this rotation, we designed the Efficiency Accelerator to enhance trainee clinical efficiency. The Accelerator consists of a single introductory didactic session, followed by daily coaching cycles. The 20‐minute didactic session includes a review of types of waste present in clinical systems, factors known to impact hospitalist efficiency, and tensions inherent in pursuing both efficient practice and patient‐centered care. On subsequent days, the attending physician leads 5‐minute Reflection‐Coaching‐Practice cycles. In Reflection, the resident creates a rough process map of one part of the day’s work (e.g., getting sign‐out through patient pre‐rounding) and identifies what deliberate strategies, if any, were used to triage priorities and navigate detours. In Coaching, the attending facilitates an analysis of workflow improvement opportunities and helps the resident develop an action plan that is recorded on an electronic gap‐analysis worksheet. In Practice, the resident implements the action plan the following day. This leads to another Reflection‐Coaching‐Practice cycle. Over five months in 2013, all seven residents on the rotation prospectively identified efficiency as one of their educational objectives and participated in the Accelerator. In post‐rotation surveys, all residents stated they received regular efficiency coaching and 100% felt that the Accelerator was “useful” or “very useful.” All residents agreed or strongly agreed that the Accelerator contributed to “improved clinical efficiency” and was likely to “change my practice with regard to clinical efficiency.” These perceptions were sustained in follow‐up evaluations conducted at least one month after the rotation. Furthermore, at the request of residents, the Accelerator model was implemented within other rotations including med consult.
Conclusions:
A formal efficiency coaching framework can be integrated into inpatient rotations in a way that aligns the efficiency priority of trainees with the clinical practice environment’s demand for timely care. This framework requires minimal time investment, no new monetary resources, and is scalable to virtually any training environment.