Browsing by Subject "process improvement"

Now showing 1 - 3 of 3
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    Engaging All Stakeholders to Create a Trusted, Data-Driven, Process Improvement Approach to Addressing Learner Mistreatment
    (Taylor & Francis, 2022-09-15) Walvoord, Emily C.; Howenstine, Michelle S.; Allen, Bradley L.; Ribera, Amy K.; Nabhan, Zeina M.; Tori, Alvaro J.; Eichholtz, Rebekah D.; Dankoski, Mary E.; Family Medicine, School of Medicine
    Problem: Learner mistreatment has remained an ongoing challenge in academic medicine despite accreditation requirements mandating that every program has systems in place to prevent and respond to mistreatment. While efforts vary across institutions, much remains unanswered in the literature about best practices. Additionally, for the foreseeable future, challenges in the learning environment will likely continue and potentially worsen, given the confluence of multiple external stressors including the COVID-19 pandemic, faculty burnout and general political divisiveness in the nation. It is essential, therefore, to focus on indicators of improvement via process metrics such as knowledge and awareness of mistreatment policies and procedures, willingness to report, reasons for not reporting, and satisfaction with having made a report, while simultaneously focusing on the more complex challenge of eliminating mistreatment occurrences. Intervention: We describe the aspects of our mistreatment prevention and response system first implemented in 2017 along with process and outcome measures. The interventions included expanding our policy outlining appropriate conduct in the teacher-learner relationship; a graduated response protocol to allegations of mistreatment with a clear escalation approach; an online reporting system; a graduate medical education exit survey which mirrors the AAMC Graduation Questionnaire on mistreatment; a robust communication and professional development campaign; a comprehensive data dashboard; and a comprehensive summary report dissemination plan. Context: The interventions were implemented at the largest allopathic medical school in the U.S., with nine campuses across the state. The system is available to all learners, including medical students, graduate students, residents, and fellows. Impact: Both institutional and national data sources have informed the continuous improvement strategies. Data from internal reporting systems, institutional surveys, and national data are presented from 2017 to 2021. Findings include an increasing number of incidents reported each year, including confidential reports from students who include their contact information rather than report anonymously, which we view as an indicator of learner trust in the system. Our data also show consistent improvements in learners’ awareness of the policy and procedures and satisfaction with having made a report. We also include other data such as the nature of complaints submitted and timeliness of our institutional response. Lessons Learned: We present several lessons learned that may guide other institutions looking to similarly improve their mistreatment systems, such as a close partnership between faculty affairs, diversity affairs, and educational affairs leadership; communication, professional development, and training through multiple venues and with all stakeholders; easily accessible reporting with anonymous and confidential options and the ability to report on behalf of others; policy development guidance; data transparency and dissemination; and trust-building activities and ongoing feedback from learners.
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    It Worked There, So It Should Work Here: Sustaining Change while Improving Product Development Processes
    (Wiley, 2019-04) Collins, Shawn T.; Browning, Tyson R.; Technology and Leadership Communication, School of Engineering and Technology
    Organizations operate under ongoing pressure to conduct product development (PD) in ways that reduce errors, improve product designs, and increase speed and efficiency. Often, managers are expected to respond to this pressure by implementing process improvement programs (PIPs) based on best practices elsewhere (e.g., in another part of their organization or in another industrial context). Successful PIP implementation depends on two criteria: (a) demonstrating (symbolic) success by meeting externally imposed deadlines and producing mandated artifacts and (b) sustaining the expected (substantive) changes in their employees' underlying beliefs and practices. Given the mixed success of PIPs in nonmanufacturing contexts, identifying factors that contribute to both symbolic and substantive implementation is important to both researchers and practitioners. We explore this challenge through an in‐depth field study at a PD company (DevCo) that implemented a PIP across its 11 PD projects. We examine DevCo's change message to implement the PIP, how DevCo's engineers experienced it, factors that impeded implementation, and factors that could improve substantive success. Along with this empirical evidence, we leverage organizational change concepts to facilitate effective PIP implementation in new contexts such as PD. We distill our findings into eight propositions that expand theory about effectively transferring PIPs across contexts.
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    Practical Implementation of Emergent After-Hours Radiation Treatment Process Using Remote Treatment Planning on Optimized Diagnostic CT Scans
    (Springer Nature, 2022) Fakhoury, Kareem R.; Schubert, Leah K.; Coyne, Mychaela D.; Aldridge, Wes; Zeiler, Sabrina; Stuhr, Kelly; Waxweiler, Timothy V.; Robin, Tyler P.; Schefter, Tracey E.; Kavanagh, Brian D.; Nath, Sameer K.; Radiation Oncology, School of Medicine
    The purpose of this report is to present the implementation of a process for after-hours radiation treatment (RT) utilizing remote treatment planning based on optimized diagnostic computed tomography (CT) scans for the urgent palliative treatment of inpatients. A standardized operating procedure was developed by an interprofessional panel to improve the quality of after-hours RT and minimize the risk of treatment errors. A new diagnostic CT protocol was created that could be performed after-hours on hospital scanners and would ensure a reproducible patient position and adequate field of view. An on-call structure for dosimetry staff was created utilizing remote treatment planning. The optimized CT protocol was developed in collaboration with the radiology department, and a novel order set was created in the electronic health system. The clinical workflow begins with the radiation oncologist notifying the on-call team (therapist, dosimetrist, and physicist) and obtaining an optimized diagnostic CT scan on a hospital-based scanner. The dosimetrist remotely creates a plan; the physicist checks the plan; and the patient is treated. Plans are intentionally simple (parallel opposed fields, symmetric jaws) to expedite care and reduce the risk of error. Education on the new process was provided for all relevant staff. Our process was successfully implemented with the use of an optimized CT protocol and remote treatment planning. This approach has the potential to improve the quality and safety of emergent after-hours RT by better approximating the normal process of care.