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Encouraging Residents to Participate in Hospital-Wide Quality Improvement

Shashank Ravi, MD

As I cleared my voice, preparing to open my first council meeting one year ago, doubt crept back into my mind, would they really listen to me? Will people participate? Is everyone here just for the free food?

I initially became involved in our hospital’s Resident Quality and Safety Council (RQSC) as an intern, interested in a career in emergency medicine administration and motivated to interact with residents across different specialties. While I sat quietly through my first several monthly meetings, I appreciated the different motivations behind resident comments—exasperation that workflows were inefficient, curiosity as to what a fishbone diagram was, worry that a reported near miss could have just as easily lead to an adverse patient outcome. While many members had no formal training in quality improvement, the counsel served as a venue for residents to get involved in improving quality and safety across the institution.

Now having just completed my year as chair of RQSC, and as a senior resident, I can more fully appreciate the importance of resident involvement in quality and safety work. Over the past year, this has included efforts towards reducing hospital acquired infections, improving the consult process throughout our institution, and consistent resident participation in root cause analyses. Our organization also plans and hosts an annual Resident Patient Safety Symposium, a half-day event highlighting the work residents across specialties have contributed to QI.

However, there remain several barriers to resident involvement in quality improvement. Time is critical for residents as they juggle clinical responsibilities, and departmental educational requirements. Resident culture is also a recognized barrier with the need to dispel myths that quality improvement vehicles including the peer review process or quality event reporting as punitive and not the constructive process that we all aim for. Lastly, residents often respond to different types of data and information. One example includes in work towards reducing HAIs, they requested more personalized and program specific data, which our hospital was able to provide.

Residents truly want their voices heard and ideas regarding quality improvement considered ( and yes free food is always a plus). Engaging residents in an organized fashion similar to our council structure, not only allows residents to learn firsthand how to plan and implement change, but allows hospital administration to tap into the practical front-line knowledge that residents bring to the table. This critical access point for resident involvement in quality work has been valuable to all involved and if not already in place at your institution, I encourage exploring developing one.


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