Quest for Excellence

Quest for Excellence is our vision of creating exceptional patient experiences through continuous improvement. Our institutional challenge is “to be better tomorrow than we are today!”

We strive to provide the best patient care in a safe and efficient environment. We work towards this goal every day through continuous process improvement, leadership development, using lean methodology. As a resident in our program, you will have the opportunity to integrate your clinical education into a culture of excellence in quality and safety that is designed for physician leaders.

Quest for Excellence is closely aligned with the CLER Pathways to Excellence. Quest has four areas of focus designed to help us along our continuous improvement journey. These interdependent areas of focus include:

CLER Pathways to Excellence

NGMC is one of a handful of sponsoring institutions created after the ACGME developed its CLER Pathways to Excellence. These pathways are seen by the ACGME as essential to creating an optimal learning environment.

The CLER Pathways include six focus areas: patient safety, health care quality, care transitions, supervision, well-being, and professionalism.  There are multiple pathways in each of the focus areas, and each pathway includes key properties that can be used for assessment at the institutional level.

At NGMC we start every day with Safety.  Each of our 300+ daily huddles begins with a review of the safety tool of the month, a safety story and celebration of good catches.  The culture of safety is a key component of every employee’s job.

The ACGME believes in the importance of education around patient safety and quality improvement, stating the following in their program requirements:

“All physicians share responsibility for promoting patient safety and enhancing quality of patient care. Graduate medical education must prepare residents to provide the highest level of clinical care with continuous focus on the safety, individual needs, and humanity of their patients.”

It is our goal to deliver high quality, cost-effective care to all of our patients. Our GME program is based on continuous quality improvement, utilizing the PDCA cycle (Plan, Do, Check, Act). Residents are expected to participate in ongoing quality projects, including the “Choosing Wisely” campaign and the yearly Quality Summit.

Residents will receive routine quality reports based on their own patient metrics. These may include preventive measures (e.g., mammogram rates), chronic disease metrics (e.g., mean HgA1c percentage) or hospital measures (e.g., length of stay).

Transitions of care happen on a daily basis in the acute care setting. Our residents and physicians participate in IDT (Interdisciplinary Team) rounds each day in a variety of settings including the ICU and the inpatient floor.

All residents and faculty physicians receive training regarding the ACGME’s supervision requirements. We believe in the process of progressive authority, allowing a resident to obtain more and more autonomy as he/she develops and demonstrates more competence.

Residency and fellowship can be an inherently stressful time in the career of a physician, and the well-being of our trainees is something we take very seriously at NGMC. Declines in physician well-being are linked to lower quality patient care and patient satisfaction, increased errors, and decreased health system performance.

Our goal is to ensure that our residents and fellows are equipped with the tools and resources that enable them to be their best so they can provide the highest quality care for our patients.

We believe that professional identity formation as a physician professional is a key aspect of residency training. We have created cross-specialty learning communities that focus on the development of attitudes and beliefs core to becoming a caring and compassionate physician. Each of the learning communities is led by a physician advisor and meets regularly as part of the Core Educational Curriculum.

The Importance of Patient Safety & Quality (PS&Q)

NGMC is dedicated to building Safety CHAMPS in healthcare. That said, there are numerous ways that safety and quality can be impacted. Wellness, fatigue, unwillingness to ask questions, or even not having the willingness to speak up, can all lead to increased risk which result in potential safety incidents and/or errors.

Our program of “Building Safety CHAMPS” has a goal of ZERO preventable harm.

  • Communicate Clearly
  • Handoff Effectively
  • Act with a Questioning Attitude
  • Maintain Your Wingman at All Times
  • Pay Attention to Detail
  • Speak Up for Safety

Patient Safety and Quality are monthly topics as a part of our Cornerstones of Resident Education (CORE) curriculum.

“A culture of safety requires continuous identification of vulnerabilities and a willingness to transparently deal with them. An effective organization has formal mechanisms to assess the knowledge, skills, and attitudes of its personnel toward safety in order to identify areas for improvement.”

– Quote from the ACGME –

Leadership Development

In most residency training programs, the focus is mostly (or wholly) on clinical skill development. At NGMC, we believe that leadership development is also a skill that must be developed.

Our curriculum is structured around three major competencies: personal authenticity, interpersonal effectiveness and continuous improvement. This leadership development model includes emotional intelligence and professional competence; effective communication and building trust; and vision, innovation and change management.

Error Prevention Toolkit
We have also developed an Error Prevention Toolkit (EPT) training program for leaders and front-line staff to ensure that we are moving forward with our safety initiatives using existing infrastructure, and not creating another system. The EPT training course was first rolled out in 2016 and is now required for all employees and physicians. Our entire Medical Staff has been trained! Each month, we focus on a different safety tool and safety behavior.

Learning from Toyota

The primary task of Toyota’s managers and leaders does not revolve around improvement…but around increasing the improvement capability of people. That capability is what, in Toyota’s view, strengthens the company.”

– Mike Rother, Toyota Kata

Lean is a customer-focused strategy that was developed and popularized by the Toyota Motor Company. It involves a relentless pursuit of waste, where waste is defined by the customer who is a patient in the healthcare system. Waste is generally defined as something that the patient does not see as having value.

Our structured curriculum teaches you about process and flow, elimination of waste (or muda), the value of humble inquiry, a questioning attitude and the PDCA model.

Daily Management System

Every day in the modern healthcare system, we deal with unavailable supplies, missing information, broken equipment, difficult to follow procedures and other barriers to providing efficient and effective care. In most systems, we develop workarounds and put out fires, but we never seem to solve the problem. Over time, these problems become the norm.

One of the methods we address this in our system is our daily management system which consists of tiered huddles. These huddles provide an opportunity for staff to identify and work through problems that get in the way of patient safety. At each of the 410 huddles that occur across the system, teams determine the readiness for delivering safe and effective patient care, efficient use of resources, and good patient flow.

GME Huddle
Tier 1 Huddle