Development of Team Action Projects in Surgery (TAPS): a
multi-level team-based approach to quality improvement
Sandra L Wong MD MSDepartment of SurgeryUniversity of Michigan
Educating for quality: Leveraging national and local partnerships for improving value and
educating for quality
Burning platform for change
Bringing stakeholders together to address problems and continuously improve the quality
of patient care
connect
collaborate
succeedTransformed OrganizationIndividuals
Opportunities within the Department of Surgery
• Quality improvement (QI)– Gaps in care – Opportunities in training for QI
• Stakeholder engagement– Shared goals in QI– Connecting and collaborating with colleagues
• Professional development– Opportunities for leadership/mentorship development– Multi-level team building
Team Action Projects in Surgery(TAPS)
Faculty
Resident
Medical students
Other students/ learners
Faculty lead– content expertise, resources
Resident or resident teams– identification of a QI area, framing the project, didactic and action-based learning about QI
Student teams– research experience, data collection/analysis
Collaboration with other colleagues
TAPS: A win-win-win
faculty
resident
student
student
resident
student
faculty
resident
student
student
resident
student
Leadership development, clinical quality improvement
(“training the trainer”)Leadership development, fulfills upcoming GME core
competency requirements
Research opportunity,
investment in the academic
pipeline
Program elements
• Key faculty elements– Residency program requirements– QI training– Doing the work of quality improvement– Feeding the academic pipeline– Faculty development
• Key trainee elements– QI training– Doing the work of quality improvement– Leadership development
TAPS Implementation• Faculty mentors
– “Training the trainers”• Didactic/core curriculum
– Learning the basic tenets of quality and safety– Leveraging health services research expertise– Lean Training
• Managing to Learn curriculum• A3 structured problem solving process• Coaching available for current state mapping, value stream
mapping, catchball, etc.
TAPS Implementation
• Team projects (practicum) for residents during their academic development time
• Setting up teams – Premeds, engineering undergrads, M1-M2s, M4s– Interprofessional collaboration
Making it work
• Specific to an academic general surgery program– Didactic curriculum in PGY 1-3 years– TAPS “practicum” during dedicated academic
development time resident-driven QI project• Generalizability
– Scale projects based on time availability– Look for opportunities within training programs
TAPS– Terry Shih’s project
Wong
Shih
M4s: Hiller, Seo, Hariharan,
Smith
Faculty
Students
Identified problem: Very high rates of C. Difficile infection and variation in treatment patterns
A3: Wide variation in processes of care between units/among providers; Weak knowledge base, poor implementation of hospital guidelines
Gemba: Examine variation by services, unit;Collect data regarding current practices and current knowledge base
Infectious diseases,
Epidemiology
TAPS– Bryner & Krell’s project
Surgery faculty: Minter & Wong
Ben BrynerRobert Krell
Industrial Engineeri
ng/ Operatio
ns Manage
ment students
Medical students
Identified problem: Process for adult general surgery consults is inefficient and can lead to errors/delays in care
Emergency Department physicians
Hospitalists
TAPS– Seth Waits’ Project
Faculty: Englesbe, Campbell
Resident: Waits
Med Students Barnhart, Sheetz
Undergrads
Lee, Cron
Nursing Student
Reser
Improving Length of Stay Following Donor Nephrectomy
What does QI mean to a resident?
Developing the Idea
• Boots on the ground - Personal Stake
• Must be achievable/timely
• Capitalize on individual interest
Drafting the Team
Process Design
Project Planning and Conception
Data Collection “Gemba”
“Gemba”
Feasibility and Testing
Implementation
Funding
• Opportunity to apply for funding and improve grant writing skills
• Paid for expenses of 6 students for the summer with funding from an internal grant
• Transforming Learning for a Third Century
Lessons Learned
• Leadership and innovation can come from any maturity of learner
• Personal Stake Leads to Motivation• Everyone feels promoted
– Resident Young Faculty– Medical Student Resident– Undergraduate Medical Student
“In the beginner’s mind there are many possibilities, in the experts mind there are few”
-Shunryu Suzuki