Innovating in Education and Patient Care to Reshape the ... in... · Vineet Arora MD MAPP. AIAMC...

Vineet Arora MD MAPPAIAMC 2019 ANNUAL MEETING

Innovating in Education and Patient Care to Reshape the Future: Medical Education 2030 and Beyond

Objectives

Learn a conceptual framework for how bridging leadership can promote alignment between education and exceptional clinical care Learn to create educational initiatives to

promote alignment; Learn how to create health systems

innovation that aligns with needs of trainees

2

It is 2030

PresenterPresentation NotesDr. Arora will review a conceptual framework for how bridging leadership can promote alignment between education and exceptional clinical care; discuss how to create educational initiatives to promote alignment; and discuss how to create health systems innovation that aligns with needs of trainees

PresenterPresentation NotesPersonalized medicine

https://www.thrombocyte.com/wp-content/uploads/2015/10/umbilical-cord-blood-banking-growth.jpg

Alexa/ai

Coding toy of the year

http://www.gadgetrx.net/the-next-generation-of-coders/

http://apunkt-hamburg.winball2.de/wp-content/blogs.dir/sites/102/2013/12/Homosapiens_Digitalis_800px.jpg

“The arrival of Gutenberg’s printing press, in the 15th century, set off another round of teeth gnashing. The Italian humanist Hieronimo Squarciaficoworried that the easy availability of books would lead to intellectual laziness, making men “less studious” and weakening their minds.”

https://www.goodreads.com/book/show/19193728-is-google-making-us-stupid

https://policyviz.com/2016/01/29/the-attention-span-statistic-fallacy/

Innovations in Medical Care Today


“Genomic Prescribing

System” (GPS)

from Ratain CPT 2007

https://cpt.uchicago.edu/

Slide courtesy Peter Odonnell MD

AI to Warn Clinical Team about a Patient Risk

21Slide courtesy Dana Edelson MD

http://www.quanthc.com/ecart

Post-Discharge Physical Therapy EngAGE©: A Program That Delivers Audio and Visual Exercise Instructions & Socially

Motivating Messages to Older Adults Through A Smart Speaker

Mobile App

Website

Photo by rawpixel on Unsplash

Photo by rawpixel on Unsplash

Smart Speaker

Caregiver

Older Adult

Let’s start arm curls. Find some

hand weights, water bottles, or

soup cans…

You have a new message from

Ellen: ‘Keep up the great work, mom!’

Authors: Huisingh-Scheetz M & Hawkley L; Programmers: Orbita, Inc.

PresenterPresentation NotesThe result of this approach has been a program that we currently call EngAGE. The program utilizes a browser, a web application for smart phones, and a smart speaker with a screen. Older adults primarily interface with the smart speaker which delivers audio and visual rehab instructions for daily, tailored exercises from the NIA Go4Life program. The exercises change daily to target different muscles and auto-adjust intensity and frequency based on user level of difficulty rating.

The caregivers primarily interface with the browser and mobile app components which allow them to both see the exercise routine for the older adult and view how adherent their family member or client has been over time. The caregivers also receive an email with summaries of adherence every day with a prompt for sending a message of encouragement through the portal. This message is then read out loud to the older adult the next time they do an exercise routine on the smart speaker to encourage long-term adherence.

https://unsplash.com/photos/kH3CTCnuD_Y?utm_source=unsplash&utm_medium=referral&utm_content=creditCopyTexthttps://unsplash.com/search/photos/older-adult?utm_source=unsplash&utm_medium=referral&utm_content=creditCopyTexthttps://unsplash.com/photos/Ur-PmBdKmlI?utm_source=unsplash&utm_medium=referral&utm_content=creditCopyTexthttps://unsplash.com/search/photos/adult-woman-using-phone?utm_source=unsplash&utm_medium=referral&utm_content=creditCopyText

Healthcare Teams Today

https://www.tvinsider.com/719261/chicago-med-season-4-premiere-rachel-dipillo-leaves/http://anewdomain.net/types-of-doctors-real-world/

Medical Training Now


Current State of Medical Training

Apprenticeship model Uniform timeline Standardized testing Service vs. learning Duty hours debates

25

Are we stuck with a QWERTY keyboard?

How Do We Innovate?


What kills innovation?

Innovation is hampered by:

ExpertthinkGrouptthink

Surrounding yourself with like-minded individuals

28

Key to Innovation: Zero Gravity Thinkers

Psychological distance: maintain an open mind.

Diverse interests: a wide range of interests, experiences, and influences

Expertise in intersectoral areas: strength in a relevant area may lead to "intersection points" at which solutions are often found

29

https://twitter.com/bob_wachterhttps://books.google.com/books/about/The_Digital_Doctor_Hope_Hype_and_Harm_at.html?id=qO-VBgAAQBAJ&source=kp_cover

Role of Brokers in Innovation Brokers

Member in multiple groups—powerful transmitter of information

People connected to groups beyond their own can expect to find themselves delivering valuable ideas, seeming to be gifted with creativity. This is not creativity born of genius, but as an import-export business. An idea mundane in one group can be valuable insight in another.

Ron Burt, PhD

https://www.uchicago.cn/events/ronald-burt-on-network-gossip-the-social-origins-of-reputation/https://www.chicagobooth.edu/

Diverse Types of Innovation

31

Minute Clinic

ScribesPrimary Care

Delivery Innovations

Personalized Medicine Initiatives

http://enterpriseresilienceblog.typepad.com/enterprise_resilience_man/best_practices/page/7/http://www.foliomag.com/inside-harvard-business-reviews-plans-to-boost-high-frequency-traffic/

Marketing Innovation is Necessary

32

Figure adapted from Satpathy R

https://www.slideshare.net/RajeshSatpathy/4-five-m-of-advertising

Overcome the Status Quo

Status quo bias an emotional preference for

the current state of affairs Any change from baseline is

perceived as A LOSS

“nudges” needed to promote better decisions about personal health Adapt nudges to clinician behavior

PresenterPresentation NotesRaises "serious questions about the rationality of many judgments & decisions that people make”

Aligning Innovation in Training & Care


Bridging Leaders as “Brokers”

PresenterPresentation NotesIn a recent JAMA article, I worked with Reshma Gupta an RWJ fellow at UCLA to highlgiht a new vision for how to merge the health syste and education siloes… this included 3 parts.

http://www.orlgao.com/single-post/2014/12/02/Tromboprofilassi-in-chirurgia-ORL-lo-score-di-Caprini-Interessante-studio-su-JAMAhttps://www.sciencedirect.com/journal/healthcare

Clinical Operations Education

Implement & scale evidence-based interventions to improve care

Foster development & testing curricula aligned with clinical operations

Develop & implement delivery innovations to improve operations

Disseminate innovations to frontline clinicians to improve their learning

Implementation Science

Dissemination Expertise

Bridging Leader to Broker Innovations Between Education & Clinical Enterprise

Adapted from Moriates & Arora. Healthcare

Supervision

Healthcare Quality

Transitions of Care

Patient Safety

Duty Hours

Professionalism

Engaging Zero Gravity Thinkers

Provide Framework for Sustaining Practice Innovations in Value

Interventions Description Skip the Drips

C Culture Valuing cost-consciousness and resource stewardship at the individual and team levelSubspecialty faculty

champions recruited to email peers

O OversightRequiring accountability for cost-conscious

decision-making at a peer and organizational level

Pharmacy receives a monthly audit of PPI drips ordered

and why

SSystems Change

Creating systems to make cost-conscious decisions using institutional policy, decision-

support tools, and clinical guidelines

Epic now requires indications for PPI drips when ordering

T Training Providing knowledge & skills clinicians need to make cost-conscious decisions“Brochures” on Skip the

Drips shared in workrooms & at morning report

Adapted from Understanding Value-Based Healthcare

PresenterPresentation NotesThis gives you a high level view of the taxonomy, we have put considerable thought and effort into how to elaborate this and are in the process of developing education materials.

Market with Right Message & Messenger

40

Choosing Wisely ChallengeSKIP THE DRIPS

Improve meaningful use of continuous infusions to improve value of care

•Goals Improve survival from life threatening GI bleedAvoid complications such as C diff Improve likelihood of successful endoscopy

•Recommend Pre-endoscopy: reserve PPI drip for suspected

high risk upper GI bleeds. Post-endoscopy:• All PPIs should be discontinued unless endoscopy identifies

ulcers or erosions• Continuous IV PPI can be used for ulcers with high-risk lesions

PPI FOR UPPER GI BLEED

Special thanks to UCM Office of Clinical Effectiveness, led by Michael Howell, MD.

Dr. Gautham Reddy, GI Fellowship Program Director

Skip the Drips: Inappropriate PPI Orders

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Jul-14 Aug-14Sep-14 Oct-14 Nov-14Dec-14 Jan-15 Feb-15 Mar-15

Apr-15 May-15

Jun-15 Jul-15 Aug-15Sep-15 Oct-15 Nov-15Dec-15 Jan-16 Feb-16 Mar-16

Apr-16

+ 3 SD

- 3 SD

Mean

Statistical process control chart using standard UCL (LCL/UCL is defined by +/- 3 standard deviation)

Nikhil Bassi

42

Patient List Indicators for Tele /Foley

Charlie Wray

Usage of Telemetry & Foley with FLIP

Wray, Farhenbach, Howell, Arora.

97% scheduled

29% “No Show” or

cancelled first new PCP visit

44% saw correct PCP

By 6 months, 19% lost to follow-up

Transitioning to 3rd PCP in 5 yrs By 3 months,

26% of ALL patients had ED visit or

hospital stay

Resident ownership a problem: 48% PGY2s reported patients not ‘theirs’ until seen in clinic

Studying PCP Handoffs in Resident Clinic

Pincavage et al.: JGIM 2012

Amber Pincavage

PresenterPresentation NotesThese findings prompted my colleague Amber Pincavage to look at the outcomes for high risk patients after the clinic handoff in 2010.They found that while 97% patients were scheduled….. In addition, when they surveyed the residents to get their perspectives on the handoff, they found … which only worsens the problem.

The high no show rate and poor outcomes emphasize the importance of understanding the patient factors in the handoff.

Innovations Emerged from Patients Notify and prepare patients for the handoffTelephone visits with the new physicianGive guidance to residents how to assume careRecognize patients for their role as valued educators of traineesImportance of personal sharing Empower patients during the handoff

PresenterPresentation NotesSince no research has examined the patient experience after undergoing clinic handoffs, we interviewed over 100 patients in 2011 over the telephone to research the barriers they faced as well as patient-identified solutions to improve the handoff. We identified the following patient-centered solutions… and decided to create a patient transition packet to address them.

Recognize patients for

role in training mission

PresenterPresentation Notes

t

Improve Recall of Packet

PresenterPresentation NotesAlso this year as part of the project, we decided to make a comic to help draw attention to the packet and help patients understand the handoff better. We partnered with a nurse who is a comic book artist to draw the comic and then incorporated feedback on the comic from several patient advocates.

Rates Acute Care & Loss to Follow Up

Pincavage, et al AJM 2014
PresenterPresentation NotesFewer patients missed their first visit with their new physician (43% 2011 vs. 31% 2012, p

Inter-departmental QI/Safety Curriculum

Leaders at Resident Forum, Resident Advisory Committee, GMEC

http://www.acgme.org/What-We-Do/Initiatives

Program Aim: to engage residents, nurses, & other staff in institutional performance improvement through approaches at two levels:

Unit-level: unit-based teams, composed of Resident-Nurse champions, who work to identify & implement practice changes that improve both care & learning

Institution-level: institutional performance improvement “mini Kaizen” events to engage residents & staff on improving issues for which they are stakeholders & process owners.

IGNITEImproving GME-Nursing Interprofessional Team

Experiences

PresenterPresentation NotesSLIDE 1: BRIEF IGNITE INTRO

Our major project is called IGNITE (Improving GME-Nursing Interprofessional Team Experiences) Aim: to engage residents, nurses, & other staff in institutional performance improvement through approaches at two levels: The program operates at 2 levelsUnit-level: unit-based teams, composed of Resident-Nurse champions, who work to identify & implement practice changes that improve both care & learningInstitution-level: institutional performance improvement “mini Kaizen” events to engage residents & staff on improving issues for which they are stakeholders & process owners.

Patients not always localized Absence of a nursing school

Why ?

PresenterPresentation NotesDebiRationale Benefits of interprofessional collaboration2 specific issues we face at UCM

52

IGNITE Internal Medicine

Project aim: Improve efficiency of multidisciplinary rounds via structured reporting tool Metric: resident report time

IGNITE Pediatrics

Project aim: Improve MD/RN communication via including RN on morning bedside roundingMetric: % nurses attend rounds

IGNITE Surgery

Project aim: Improve the % of patients who understand their discharge teaching early in the morning of day of discharge Metric: teach-backs failed

IGNITE Kaizen - Peripheral IV Placement

Project aim: Improve policy/procedures for inpatient peripheral IV placementMetric: fewer patients with more than 3 sticks

IGNITE Neurology

Project aim: Improve shared mental model of MD/RN on-call issues overnight via afternoon B-BRAINS huddleMetric: on-call pages at night

IGNITE Ob\gyne

Project aim: Improve % low-risk patients discharged before noon via enhanced MD/RN communication after attending rounds Metric: Discharge before noon

IGNITE Kaizen - Transportation Delays

Project aim: improve processes to reduce patient transportation delaysMetric: reduce in-hospital transport delays for testing and procedures

IGNITE Orthopaedics

Project aim: Improving discharge communication to patients via standard EHR-based discharge templateMetric: Pages regarding discharge instructions

Coh

ort 1

Kai

zen

Coh

ort 2

What does this look like?

Teamwork and Communication 2017-2018 YoY Score Difference

53Te

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ork

and

Com

mun

icat

ion

2017

-201

8 Sc

ore

Diff

eren

ce

Rank Order (biggest decrease to biggest increase)Includes Adult Inpatient units only

Scor

e in

crea

sed

2017

-201

8Sc

ore

decr

ease

d 20

17-2

018

IGNITE Participant

Chart1

Pediatrics - Critcal Care (PICU)

Emergency Medicine (ED)

Surgery - Transplant (Surgical ICU, 3W)

Medicine - Hem/Onc (10E, 10W)

Medicine - Hospital Medicine (3SE, 3SW, 5SE)

Pediatrics - Hema Oncology (Comer 6)

Surgery - Cardiac, Vascular (4E, 4W)

Surgery - General, OHNS, Plastics (3C)

Orthopaedics, Surgery - Urology (8W)

Medicine - Gen Int Med (9E, 9W)

Surgery - Neurosurgery (8N)

Pediatrics - Neonatology (NICU)

Pediatrics - General Peds (Comer 5)

8 East - Neuro

OB & Gynecology (L&D)

Medicine - Cardiology (4C)

Unit J

Unit I

Unit H

Unit G

Unit F

Unit E

Unit D

IGNITE - Unit

IGNITE - Unit

IGNITE - Unit

Unit C

Unit B

IGNITE - Unit

IGNITE - Unit

Unit A

IGNITE - Unit

-0.61

-0.28

-0.26

-0.17

-0.15

-0.1

0.03

0.06

0.06

0.07

0.11

0.15

0.22

0.39

0.37

0.45

Sheet1

Category2017 - Engagement Indicator2017 - Leadership Domain2017 - Organization Domain2018 Number of Responses2018 - There is effective teamwork between physicians and nurses at UChicago Medicine.2018 - Communication between physicians, nurses, and other medical personnel is good at Uchicago Medicine.2018 - Average score: Teamwork and Communication2017 Number of Responses2017 - There is effective teamwork between physicians and nurses at University of Chicago Medicine.2017 - Communication between physicians, nurses, and other medical personnel is good in UCM.2017 - Average score: Teamwork and Communication2016 Number of Responses2016 - There is effective teamwork between physicians and nurses at University of Chicago Medicine.2016 - There is effective communication between the nursing staff and physicians regarding patient care2016 - Average score: Teamwork and Communication

All Hospital Physicians (Hospital medicine units)

Hospital Physicians Score3.863.63.767273.873.683.787263.873.613.746223.753.753.75

UCM Staff Score3.943.743.693.593.393.4936473.513.303.4134313.553.353.45

Score difference0.080.140.070.280.290.290.360.310.340.200.400.30

Emergency Medicine (ED)


UCM Staff Score3.93.423.57952.882.742.81563.322.963.14653.573.073.32


Weighted Average (Hospital Physicians and UCM Staff)3.042.872.963.403.073.243.693.233.46

Ob & Gynecology (L&D)


UCM Staff Score3.663.343.33553.172.923.05542.692.432.560.00



Pediatrics - Critical Care (PICU)


UCM Staff Score3.793.893.62853.182.933.06453.913.713.81434.053.793.92

Score difference0.190.330.160.890.820.860.090.210.15-0.45-0.19-0.32


Medicine - Cardiology (4C)


UCM Staff Score3.923.353.56783.633.463.55603.153.003.080.00



Medicine - Endocrinology, Gen Int Med (5 Gen Med, 9E, 9W)


UCM Staff Score4.214.143.91173.553.443.50763.563.353.461413.353.343.35



Medicine - Hem/Onc (10E, 10W)


UCM Staff Score3.733.233.441253.193.013.10883.343.143.24953.683.563.62



Orthopaedics, Surgery - Orthopedic & Rehab Med, Urology (8W)


UCM Staff Score3.983.843.72213.763.483.62373.493.223.36513.483.223.35

Score difference0.290.570.13-0.130.07-0.030.380.380.380.590.900.75


Pediatrics - General Peds, Neurology (Comer 5)


UCM Staff Score3.893.713.68393.643.513.58463.483.283.38353.463.483.47



Pediatrics - Hema Oncology (Comer 6)


UCM Staff Score3.843.613.66463.453.223.34393.703.323.51253.633.283.46



Pediatrics - Neonatology (NICU)

Hospital Physicians Score4.393.934.02174.314.244.28174.243.944.0910.00

UCM Staff Score3.93.553.61423.853.583.721003.713.363.54823.523.313.42



Surgery - General, OHNS, Plastics (3C)


UCM Staff Score3.383.23.24333.062.762.91282.962.792.880.00



Surgery - Cardiac, Cardiothoracic, Vascular (4E, 4W)


UCM Staff Score4.023.713.731413.563.353.461413.543.243.39883.713.373.54



Surgery - Neurosurgery (8N)


UCM Staff Score4.063.83.66253.43.123.26323.133.063.10403.283.063.17



Surgery - Transplant (Surgical ICU, 3W)

Hospital Physicians Score3.173.133.4673.432.432.9354.003.403.7020.00

UCM Staff Score4.324.133.98763.483.413.45733.683.633.66643.803.443.62

Score difference1.1510.52-0.05-0.98-0.520.320.230.28-3.80-3.44-3.62


Medicine - Nephrology (Acute Dialysis)


UCM Staff Score4.063.83.66213.953.763.86193.633.423.53194.113.753.93



Medicine - Hospital Medicine (3SE, 3SW, 5SE)


UCM Staff Score4.063.83.66583.073.073.07313.032.812.920.00

Score difference0.320.170.08-0.16-0.16-0.160.770.390.583.503.253.38

Weighted Average (Hospital Physicians and UCM Staff)3.013.013.013.282.943.11

Anesthesia - Anesthesiology

Hospital Physicians Score743.553.473.513.733.633.68

UCM Staff Score133.733.913.82133.783.643.7119

Score difference-0.18-0.44-0.31-0.05-0.01-0.03


Family Medicine - Family Medicine (Kibort)

Hospital Physicians Score?0.00

UCM Staff Score3-4.3344.674.254.46

Score difference0.00-4.67-4.25-4.46

Weighted Average (Hospital Physicians and UCM Staff)

Medicine Dermatology - Dermatology (Lisec)


UCM Staff Score124.083.673.88123.923.833.8812

Score difference-0.410.00-0.210.33-0.200.06


Medicine Endocrinology - Endocrinology Visits (Scott)


UCM Staff Score84.133.753.9427

Score difference-0.77-0.66-0.724.003.893.95


Medicine Gastroenterology - GI Clinic Visits (Jones)


UCM Staff Score174.254.064.16133.693.383.5494.00


Weighted Average (Hospital Physicians and UCM Staff)3.693.383.54

Medicine - Infectious Diseases - Infectious Disease (Scott)


UCM Staff ScoreNot Enough Responses

Score difference4.104.004.053.303.203.25


Medicine - Pulmonology and Sleep Medicine - Pulmonary Function (Byrd) and Sleep Lab (Buckles)


UCM Staff Score183.693.943.82153.933.853.8929

Score difference0.27-0.020.12-0.010.040.02


Medicine - Rheumatology - Rheumatology (Carey)


UCM Staff Score53.753.503.6343.753.003.38



Neurology - Neurology (Zell)


UCM Staff Score34.334.334.3374.003.500.57



Ophthalmology - Ophthalmology (Paschall)


UCM Staff Score164.003.713.86113.633.003.32



Pathology - Anatomic Pathology (Gettings) and Molecular Pathology (Benhamed)


UCM Staff Score253.343.033.19563.253.223.24



Pediatrics - Gastroenterology - Peds Gastro (Wilson)

Hospital Physicians ScoreNot Enough Responses

UCM Staff ScoreNot Enough Responses

Score difference


Pediatrics - Neurology - Peds Neurology (Wilson)


UCM Staff Score33.673.673.67



Psychiatry - Psych Adult (Banks)


UCM Staff Score94.383.784.0854.604.604.60



Radiation-Oncology - Rad Oncology (Lester)


UCM Staff Score223.593.273.43113.553.363.46



Radiology - Radiology (Lenner)


UCM Staff Score1313.803.523.661053.653.453.55



Langlois, Kalie [UCM]:CCD 10W - HON

Sheet2

Category2017 - Engagement Indicator2017 - Leadership Domain2017 - Organization Domain2018 Number of Responses2018 - There is effective teamwork between physicians and nurses at UChicago Medicine.2018 - Communication between physicians, nurses, and other medical personnel is good at Uchicago Medicine.2018 - Average score: Teamwork and Communication2017 Number of Responses2017 - There is effective teamwork between physicians and nurses at University of Chicago Medicine.2017 - Communication between physicians, nurses, and other medical personnel is good in UCM.2017 - Average score: Teamwork and Communication2016 Number of Responses2016 - There is effective teamwork between physicians and nurses at University of Chicago Medicine.2016 - There is effective communication between the nursing staff and physicians regarding patient care2016 - Average score: Teamwork and Communication

All Hospital Physicians3.863.63.767273.873.683.787263.873.613.746223.753.753.75

All UCM Staff3.943.743.693.593.393.4936473.513.303.4134313.553.353.45

Emergency Medicine Hospital Physicians3.753.843.79124.333.924.13113.823.643.73114.404.204.30

ED - UCM Staff3.93.423.57952.882.742.81563.322.963.14653.573.073.32

OBGY&N Hospital Physicians4.043.893.83463.933.833.88403.803.683.74373.403.603.50

L&D UCM Staff3.663.343.33553.172.923.05542.692.432.560.00

PICU - Hospital Physicians3.63.563.78164.073.753.91104.003.503.7553.603.603.60

PICU - UCM Staff3.793.893.62853.182.933.06453.913.713.81434.053.793.92

Cardiology - Hospital Physicians3.483.433.51234.053.873.96233.703.303.50183.883.813.85

Cardiology - UCM Staff3.923.353.56783.633.463.55603.153.003.080.00

Med /Endo/Gen Int Med - Hospital Physicians4.253.913.94534.083.833.96653.863.573.72653.503.453.48

Med/Endo/Gen Int Med - UCM Staff4.214.143.91173.553.443.50763.563.353.461413.353.343.35

Med-Hem/Onc - Hospital Physicians3.983.623.74304.003.633.82284.113.753.93284.004.004.00

Med-Hem/Onc - UCM Staff3.733.233.441253.193.013.10883.343.143.24953.683.563.62

Ortho/Surgey/Ortho Rehab/Uro - Hospital Physicians3.693.273.59333.633.553.59373.873.603.73354.074.124.10

Ortho/Surgey/Ortho Rehab/Uro - UCM Staff3.983.843.72213.763.483.62373.493.223.36513.483.223.35

Peds-Gen Peds/Neuro - Hospital Physicians3.723.293.71324.104.134.12264.213.773.99224.003.943.97

Peds-Gen Peds/Neuro - UCM Staff3.893.713.68393.643.513.58463.483.283.38353.463.483.47

Peds- Hem/Onc - Hospital Physicians3.643.23.68114.273.734.0084.003.633.8284.004.004.00

Peds- Hem/Onc -UCM Staff3.843.613.66463.453.223.34393.703.323.51253.633.283.46

Peds - NICU - Hospital Physicians4.393.934.02174.314.244.28174.243.944.0910.00

Peds - NICU -UCM Staff3.93.553.61423.853.583.721003.713.363.54823.523.313.42

Surgery - General-OHNS/Plastics- Hospital Physicians3.963.733.82623.973.793.88723.813.613.71474.084.014.04

Surgery - General-OHNS/Plastics - UCM Staff3.383.23.24333.062.762.91282.962.792.880.00

Surgery - Card/Cardio/Vasc - Hospital Physicians3.723.613.82163.943.693.81233.913.833.87183.833.833.83

Surgery - Card/Cardio/Vasc - UCM Staff4.023.713.731413.563.353.461413.543.243.39883.713.373.54

Surgery Neuro - Hospital Physicians3.743.633.7464.003.673.84113.823.643.7383.633.383.51

Surgery Neuro - UCM Staff4.063.83.66253.403.123.26323.133.063.10403.283.063.17

SICU - Hospital Physicians3.173.133.4673.432.432.9354.003.403.7020.00

SICU - UCM Staff4.324.133.98763.483.413.45733.683.633.66643.803.443.62

Nephrology (Acute Dia.) - Hospital Physicians3.743.633.7464.333.834.0883.883.753.8273.713.713.71

Nephrology (Acute Dia.) - UCM Staff4.063.83.66213.953.763.86193.633.423.53194.113.753.93

Med - Hosp Med - Hospital Physicians3.743.633.74352.912.912.91153.803.203.5043.503.253.38

Med - Hosp Med - UCM Staff4.063.83.66583.073.073.07313.032.812.920.00

Anesthesia - Hospital Physicians743.553.473.513.733.633.68

Anesthesia - UCM Staff133.733.913.82133.783.643.7119

Family Med - Hospital Physicians?0.00

Family Med - UCM Staff34.3344.674.254.46

Dermatology - Hospital Physicians33.673.673.674.253.633.94

Dermatology - UCM Staff124.083.673.88123.923.833.8812

Med Endo - Hospital Physicians113.363.093.234.003.893.95

Med Endo - UCM Staff84.133.753.9427

Med Gastro - Hospital Physicians183.563.673.624.003.893.95

Med Gastro - UCM Staff174.254.064.16133.693.383.5494.00

Med-Infectious Diease - Hospital Physicians104.104.004.053.303.203.25

Med - Infectious Diease - UCM StaffNot Enough Responses

Pulmonology/Sleep - Hospital Physicians253.963.923.943.923.893.91

Pulmonary/Sleep - UCM Staff183.693.943.82153.933.853.8929

Rheumatology - Hospital Physicians54.603.804.204.334.004.17

Rheumatalogy - UCM Staff53.753.503.6343.753.003.38

Neurology - Hospital Physicians204.163.743.953.813.483.65

Neurology - UCM Staff34.334.334.3374.003.500.57

Ophthalmology - Hospital Physicians54.404.004.204.384.254.32

Ophthalmology - UCM Staff164.003.713.86113.633.003.32

Pathology - Hospital Physicians373.683.663.673.853.523.69

Pathology - UCM Staff253.343.033.19563.253.223.24

Peds Gastro - Hospital PhysiciansNot Enough Responses

Peds Gastro - UCM StaffNot Enough Responses

Peds Neuro - Hospital Physicians53.603.003.304.003.893.95

Peds - Neuro - UCM Staff33.673.673.67

Psych Adult - Hospital Physicians133.623.003.313.583.083.33

Psych Adult - UCM Staff94.383.784.0854.604.604.60

Rad/Onc - Hospital Physicians84.294.004.154.173.894.03

Rad-Onc - UCM Staff223.593.273.43113.553.363.46

Radiology - Hospital Physicians364.003.573.793.923.893.91

Radiology - UCM Staff1313.803.523.661053.653.453.55

Sheet2

2018 - Average score: Teamwork and Communication

Sheet3


Sheet5

Sheet6

Category2018 - Average score: Teamwork and Communication

Med - Hosp Med - Hospital Physicians2.91

SICU - Hospital Physicians2.93

Med Endo - Hospital Physicians3.23

Peds Neuro - Hospital Physicians3.30

Psych Adult - Hospital Physicians3.31

Anesthesia - Hospital Physicians3.51

Ortho/Surgey/Ortho Rehab/Uro - Hospital Physicians3.59

Med Gastro - Hospital Physicians3.62

Dermatology - Hospital Physicians3.67

Pathology - Hospital Physicians3.67

All Hospital Physicians3.78

Radiology - Hospital Physicians3.79

Surgery - Card/Cardio/Vasc - Hospital Physicians3.81

Med-Hem/Onc - Hospital Physicians3.82

Surgery Neuro - Hospital Physicians3.84

Surgery - General-OHNS/Plastics- Hospital Physicians3.88

OBGY&N Hospital Physicians3.88

PICU - Hospital Physicians3.91

Pulmonology/Sleep - Hospital Physicians3.94

Neurology - Hospital Physicians3.95

Med /Endo/Gen Int Med - Hospital Physicians3.96

Cardiology - Hospital Physicians3.96

Peds- Hem/Onc - Hospital Physicians4.00

Med-Infectious Diease - Hospital Physicians4.05

Nephrology (Acute Dia.) - Hospital Physicians4.08

Peds-Gen Peds/Neuro - Hospital Physicians4.12

Emergency Medicine Hospital Physicians4.13

Rad/Onc - Hospital Physicians4.15

Rheumatology - Hospital Physicians4.20

Ophthalmology - Hospital Physicians4.20

Peds - NICU - Hospital Physicians4.28

Family Med - Hospital Physicians

Peds Gastro - Hospital Physicians

Sheet6


Sheet7

Category2018 - There is effective teamwork between physicians and nurses at UChicago Medicine.2018 - Communication between physicians, nurses, and other medical personnel is good at Uchicago Medicine.

Med - Hosp Med - Hospital Physicians2.912.91

Med Endo - Hospital Physicians3.363.09

SICU - Hospital Physicians3.432.43

Anesthesia - Hospital Physicians3.553.47

Med Gastro - Hospital Physicians3.563.67

Peds Neuro - Hospital Physicians3.603.00

Psych Adult - Hospital Physicians3.623.00

Ortho/Surgey/Ortho Rehab/Uro - Hospital Physicians3.633.55

Dermatology - Hospital Physicians3.673.67

Pathology - Hospital Physicians3.683.66

All Hospital Physicians3.873.68

OBGY&N Hospital Physicians3.933.83

Surgery - Card/Cardio/Vasc - Hospital Physicians3.943.69

Pulmonology/Sleep - Hospital Physicians3.963.92

Surgery - General-OHNS/Plastics- Hospital Physicians3.973.79

Med-Hem/Onc - Hospital Physicians4.003.63

Surgery Neuro - Hospital Physicians4.003.67

Radiology - Hospital Physicians4.003.57

Cardiology - Hospital Physicians4.053.87

PICU - Hospital Physicians4.073.75

Med /Endo/Gen Int Med - Hospital Physicians4.083.83

Peds-Gen Peds/Neuro - Hospital Physicians4.104.13

Med-Infectious Diease - Hospital Physicians4.104.00

Neurology - Hospital Physicians4.163.74

Peds- Hem/Onc - Hospital Physicians4.273.73

Rad/Onc - Hospital Physicians4.294.00

Peds - NICU - Hospital Physicians4.314.24

Emergency Medicine Hospital Physicians4.333.92

Nephrology (Acute Dia.) - Hospital Physicians4.333.83

Ophthalmology - Hospital Physicians4.404.00

Rheumatology - Hospital Physicians4.603.80

Family Med - Hospital Physicians

Peds Gastro - Hospital Physicians

xy

x-axis2.91

4.6

Sheet7

Sheet4

Sub AttachLabelsToPoints()

'Dimension variables.

Dim Counter As Integer, ChartName As String, xVals As String

' Disable screen updating while the subroutine is run.

Application.ScreenUpdating = False

'Store the formula for the first series in "xVals".

xVals = ActiveChart.SeriesCollection(1).Formula

'Extract the range for the data from xVals.

xVals = Mid(xVals, InStr(InStr(xVals, ","), xVals, _

Mid(Left(xVals, InStr(xVals, "!") - 1), 9)))

xVals = Left(xVals, InStr(InStr(xVals, "!"), xVals, ",") - 1)

Do While Left(xVals, 1) = ","

xVals = Mid(xVals, 2)

Loop

'Attach a label to each data point in the chart.

For Counter = 1 To Range(xVals).Cells.Count

ActiveChart.SeriesCollection(1).Points(Counter).HasDataLabel = _

True

ActiveChart.SeriesCollection(1).Points(Counter).DataLabel.Text = _

Range(xVals).Cells(Counter, 1).Offset(0, -1).Value

Next Counter

End Sub

Category2016, n=47342017, n=50762018, n=5332YoY Change

Pediatrics - Critcal Care (PICU)3.893.803.19-0.61

Emergency Medicine (ED)3.463.242.96-0.28

Surgery - Transplant (Surgical ICU, 3W)3.613.663.40-0.26

Medicine - Hem/Onc (10E, 10W)3.713.413.24-0.17

Medicine - Hospital Medicine (3SE, 3SW, 5SE)3.143.713.56-0.15

Pediatrics - Hema Oncology (Comer 6)3.593.563.46-0.10

Surgery - Cardiac, Vascular (4E, 4W)3.593.463.490.03

Surgery - General, OHNS, Plastics (3C)3.903.483.540.06

Orthopaedics, Surgery - Urology (8W)3.653.543.600.06

Medicine - Gen Int Med (9E, 9W)3.393.573.640.07

Surgery - Neurosurgery (8N)3.233.263.370.11

Pediatrics - Neonatology (NICU)3.503.623.770.15

Pediatrics - General Peds (Comer 5)3.663.603.820.22

8 East - Neuro0.39

OB & Gynecology (L&D)3.503.063.430.37

Medicine - Cardiology (4C)3.223.193.640.45

2016, n=4734

2017, n=5076

2018, n=5332

2016, n=4734

2017, n=5076

2018, n=5332

Conclusions

Innovation is urgently needed to ensure education is aligned with the advancements in clinical care we need to deliver in the future Bridging leadership is one way to

close this gap Health system innovations can and

should result in improved training

54

PresenterPresentation NotesLearn a conceptual framework for how bridging leadership can promote alignment between education and exceptional clinical careLearn to create educational initiatives to promote alignment; Learn how to create health systems innovation that aligns with needs of trainees

55

https://www.brainyquote.com/quotes/steve_jobs_173474

Build legacy by investing in peopleMultipliers are leaders who: Nurture & attract talent Amplify capabilities of

those around them Invest in people Get twice as much

from people

58

PresenterPresentation NotesMore than 280 physicians and other health professionals have trained at the MacLean Center, many of whom now direct ethics programs in the U.S., Canada and Europe.�

https://www.harpercollins.com/9780061964398/multipliers

Innovating in Education and Patient Care to Reshape the Future: Medical Education 2030 and BeyondObjectivesIt is 2030Slide Number 4iGen Slide Number 6Slide Number 7Slide Number 8Picture of alexa in our house (AI)Slide Number 10Slide Number 11Slide Number 12Homo sapiens digitalisSlide Number 14Slide Number 15Innovations in Medical Care TodaySlide Number 17Slide Number 18Slide Number 19Slide Number 20AI to Warn Clinical Team about a Patient RiskPost-Discharge Physical TherapyHealthcare Teams Today Medical Training NowCurrent State of Medical Training Are we stuck with a �QWERTY keyboard?How Do We Innovate?What kills innovation?Key to Innovation: �Zero Gravity Thinkers Role of Brokers in InnovationDiverse Types of InnovationMarketing Innovation is NecessaryOvercome the Status QuoAligning Innovation in Training & CareBridging Leaders as “Brokers”Bridging Leader to Broker Innovations Between Education & Clinical EnterpriseEngaging Zero Gravity ThinkersSlide Number 38Provide Framework for Sustaining Practice Innovations in Value Market with Right Message & MessengerSkip the Drips: �Inappropriate PPI OrdersPatient List Indicators for Tele /Foley Usage of Telemetry & Foley with FLIPSlide Number 44Innovations Emerged from Patients Slide Number 46Improve Recall of PacketRates Acute Care & Loss to Follow UpSlide Number 49IGNITE�Improving GME-Nursing Interprofessional Team ExperiencesSlide Number 51What does this look like?Teamwork and Communication 2017-2018 YoY Score DifferenceConclusionsSlide Number 55Slide Number 58

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