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