Tulane Internal Medicine Residency, Program Information

Quality and Patient Safety

Becoming The Master Systems Architect

Tulane is about developing world-class academic physicians…. and while not all of our graduates will pursue a career in academics, all of them will have the choice. In addition to great clinical prowess, research excellence, and master teachers… the Tulane residents develop into exceptional systems architects…. Leaders capable of changing the healthcare system upon their graduation.

The philosophy of the Tulane Team’s efforts in quality improvement and patient safety are synonymous with the central tenants of the patient safety movement:

  1. Systems drive function.

  2. Every system is perfectly designed to produce the results that it does.

  3. Everyone is trying as hard as they can, and if they are not, it’s because the system has brought them to their knees.

  4. Meaningful quality improvement is centered in teams, not individuals.

  5. Quality improvement is a “way of thinking,” not a “what of thinking.” You learn to think differently by being actively engaged in improvement, not by listening to power-point-driven lecture on quality.

  6. We cannot become who we want to be if we continue to be who we are.

  7. The same minds that created the problems cannot be the ones to change it. The same people can… but we have to change our minds.

  8. It’s easier to act your way into new beliefs than it is to believe your way into new actions.

The Tulane Quality Improvement platform is based upon these philosophical tenants. In the intern year, you will learn the principles of quality improvement such that you are prepared to utilize such tools as failure-mode effects analysis, root-cause analysis, flow-mapping, fish-boning, etc., as part of the firm’s quality improvement project in the second and third year.

In the second and third year, each firm conducts its own longitudinal quality improvement project as part of a team… once the project is decided (July), the firm alternates responsibility for collecting data, doing interviews with key stakeholders, participating on hospital committees related to the project, and in general, keeping the project moving. While each firm has a dedicated quality coach (i.e., the firm’s associate program director), the firm’s quality project is designed and operated by the residents themselves. In the context of doing so, each resident applies the higher-level skills of organization, management, and leadership that were a part of the Leadership Curriculum in the CAS series. And of course, in the context of actively applying these skills, you’ll naturally and effortlessly acquire the values and believes held in philosophical tenants 4 to 8 above. At the end of each year, each firm presents the results of their quality improvement project at Grand Rounds. The faculty and residents vote, and the winning firm has a night on the town on us!

At almost every training program, quality improvement is done solely because it’s an ACGME requirement… and the result is a collection of lame, individual projects that have no meaningful outcome for anyone involved (i.e., “Hey resident, follow 20 of your patient’s HgbA1c measurements, and then see if you can make that number lower.” Yawn…). And the other programs are likely to make you do a project that is important exclusively such that the hospital makes more money (i.e., meeting the core measures). What you’ll learn at these programs has nothing to do with quality… but the terrible lessons that quality improvement is about individuals and merely for someone else’s agenda. And worst of all, it does nothing to improve your or your patient’s lives.

Tulane embarks on Quality Improvement projects that are important to us… and to our patients. And in our efforts, we improve our efficiency, our safety and our quality of care. And since our projects result in meaningful improvement for our patients, it’s easy to put your heart, soul and back into making these projects come to fruition. Check out the firm’s quality improvement projects from last year… these are not dink projects!

Rey Firm:
Bridging the Gap: Improving Inpatient to Outpatient Communication for Hospitalized Patients

Burch Firm:
Resident Attitudes Towards and Education on HIV/AIDS Follow-up from Hospital Discharge

Musser Firm:
Can you hear me now? Decreasing the No Show Rate at the MCLNO Clinic

Mackey Firm:
Improving Patient Triage at the VA Clinic

Elliott Firm:
Changing the Standard: Targeting Discharge Summary Content Improvement Through Application of Standard Work

Wiese, National Imperative

And of course, you’ll have the luxury of training under one of the nation’s great thought leaders in quality and patient safety. As past president of the Society of Hospital Medicine, a Board member for the ACP and a Councilor for the ABIM… (not to mention the founder and recurrent keynote speaker for the Quality & Safety Educators Academy), Dr. Wiese is as good as it gets in teaching (coaching) meaningful quality improvement in residency.