The GME ripple effect on health care quality

OHSU residents and fellows are championing quality projects – and helping to change the health care system from the ground up

March 25, 2015


1st Place_QualityEvolving reimbursement models, the call for cost transparency and an emphasis on value are shaping a new lexicon of quality metrics in health care. Freshly-minted physicians increasingly leave medical school with a new understanding of, and experience with, the tools needed to drive quality improvement in health care. With their enthusiasm and willingness to innovate, residents and fellows are an unheralded but essential element of the nationwide movement to improve health care.

This ripple effect is in evidence at OHSU, the largest home to GME training in Oregon, with more than 800 house officers and 80 programs. Each year hundreds of new “quality ambassadors” begin their training and dive in to the quality movement, often generating new ideas and demonstrating – through evidence – the significant positive effect of a teaching hospital on health care delivery.

“The leadership shown by our residents on quality projects represents a cultural shift and demonstrates a strong commitment by our trainees to contribute to quality patient care at OHSU,” said Patrick Brunett, M.D., FACEP, associate dean for graduate medical education, OHSU School of Medicine.

Resident-driven quality projects are developed under the auspices of the OHSU House Officers Association and the Housestaff Quality and Safety Council (HQSC). Using a framework of lean principles and tools organized within the OHSU Performance Excellence System, or OPEx, trainees drop anchor and get to work.

The School of Medicine’s Division of Graduate Medical Education held a poster symposium during the wider OHSU Performance Excellence Week. Quality awards went to projects aimed at standardizing opioid therapy in primary care and improving evidence-based prenatal care, among others.

“OHSU residents and fellows have incredible insight into our patient care mission, and it’s exciting to see their commitment to quality. This excitement inspires those of us on the faculty,” said Thomas Yackel, M.D., MPH, vice president and chief clinical integration officer, OHSU Healthcare and associate dean, clinical practice, OHSU School of Medicine. 

Another recent resident-driven project enhances patient-physician communication. OHSU patient surveys frequently provide specific feedback that demonstrates the pivotal role trainees play in the patient experience. Using a “train-the-trainer” model, project leaders are equipping residents with tools to improve this critical aspect of patient care.

This year, OHSU residents are also tackling hospital transfers – an area that could easily seem formidable to a physician-in-training at a large hospital, but one that members of the HQSC have embraced as an opportunity for standardizing workflows. HQSC members aim to have a standard transfer note when new interns join OHSU this summer.

OHSU trainees have been spearheading quality projects like these for the past 11 years. As these quality ambassadors complete their training and enter practice at OHSU or elsewhere, they take their knowledge with them, turning the tide with each subsequent effort toward a system in which quality is deeply ingrained. 


Pictured above, left to right: Patrick Brunett, M.D., FACEP, associate dean for graduate medical education, OHSU School of Medicine; Family Medicine residents Brigit Hatch, M.D.; Alison Herson, M.D.; and Brian Garvey, M.D.; Charles Kilo, M.D., MPH, chief medical officer, OHSU Healthcare; and George Mejicano, M.D., senior associate dean for education, OHSU School of Medicine