Background: UChicago Medicine (UCM) Office of Operational Excellence (OE) uses an institutional Leadership model called “Engage, Evolve, Excel” (E3L) to improve care delivery with lean, six sigma, and patient centered values. The E3L model focuses on the four domains of value creation, patient-centered care, respect for people, and continuous improvement. A hallmark feature of E3L is the “Kaizen” Event, a week-long interdisciplinary team improvement process. Historically, 3.3% of Kaizen participants were physicians. While many hospitals use lean, engaging frontline clinicians, especially physicians, in Kaizen events has been a challenge.
Purpose: As a part of the Accreditation Council for Graduate Medical Education’s (ACGME) Pursuing Excellence initiative, UCM Graduate Medical Education (GME), Continuing Medical Education (CME) and health system leadership sought opportunities for resident and faculty training and engagement in quality, safety, and value through interprofessional collaboration. We aimed to develop a model that would better promote and accommodate physician faculty and resident engagement in institutional E3 Leadership activities, using Kaizen participation rates as a marker of engagement and incentivize faculty participation through CME and MOC credits. Given that a Kaizen is an interprofessional event, we also aimed to increase nursing participation.
Description: OE, GME, and health system leaders co-designed the ECLIPSE (Educational & Clinical Leaders Improving Performance with Structured E3L) program. Four online modules and one data lab train clinicians on E3L. Clinicians participate in a Kaizen event to implement the E3L principles. Modules replace 4 hours of time in Kaizen and are approved for 4.5 CME and MOC Part II credits. Kaizen participation is accredited for 20 CME and 20 MOC Part IV credits. E3L certificates are awarded after completion and final exam.In addition, we developed an annual clinician-targeted Kaizen focused on interprofessional care delivery concerns. Physicians were recruited for their expert perspective. Kaizen topics were chosen to address challenges across service lines, including general medicine and subspecialty services: • Difficult peripheral IV placement • Inpatient transport delays • Discharge delays within the 24-hour period prior to discharge
Conclusions: Over 30 physicians have certified in E3L using ECLIPSE. Since launching ECLIPSE, physician participation in Kaizen across the institution rose from 5.8% in FY2018 to 7.2% in FY19; this is a 25% year-to-year increase and nearly 2x actual physician increase. Absolute nursing participation rose by nearly 30%. The rate of first-time participants increased 3-fold year-over-year. Feedback shows 88% of participants strongly agree they would recommend ECLIPSE to a colleague. Clinical Kaizen events had the following impact: • Created sustained training of nurses in oncology unit to place ultrasound-guided peripheral IVs, with training now being expanded to another unit. • Developed a nursing alert when inpatient transport is ordered, allowing nurses to prepare patients and reduce delays. • Improved communication around discharge, including increased use of “conditional discharge” orders; changes have been associated with improved length of stay. We were able to adapt the E3 Leadership training and create a scalable engagement platform for clinicians. We use Kaizen participation rates as a marker of engagement in E3L and found ECLIPSE incentivized participation.
