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Field Trip: 11 Things the Open School Team Learned on a Visit to Boston Medical Center

By IHI Open School | Monday, August 11, 2014

Every week for the last three years, Dr. James Moses has driven from Boston Medical Center (BMC) to IHI's office in Cambridge. As the IHI Open School's Academic Advisor, he helps our team determine priorities, develop content, and engage our community of learners around the world.

Last week, for the first time, we went to visit him.

Dr. Moses is a pediatrician and the Medical Director of Quality Improvement at BMC, a safety net hospital with 496 beds and about 6,000 employees. He invited our entire team — Carly, Jess, Laura, Andy, Rachel, Mike, Stephanie, Gina, and Gaby — to the hospital for a day of tours and meetings with quality directors, risk managers, and other staff.

The site visit was, in short, one of the best learning experiences we've had. We heard about the day-to-day challenges of engaging clinicians in quality improvement and saw colleagues supporting each other to take better care of patients. It was inspiring.

Collectively, we came up with 11 takeaways from our great day at BMC:

  1. No one, no matter how hungry, wants to grab the first sandwich at a lunch meeting.
  2. BMC hired its first Chief Quality Officer in 2008, the same year IHI created the Open School. We were delighted to hear how many BMC staff have taken our courses or other IHI programs — and recommend them!
  3. Reporting medical errors is a project in itself. Years ago, BMC commissioned  an independent review that found staff reported only about 12 percent of errors. By convincing staff that error reporting is meant to help patients rather than punish clinicians, BMC is now one of the top reporting hospitals in Boston.
  4. When errors are reported, risk managers always make sure the provider is okay in addition to patients and their families. Clinicians in these events are sometimes called “second victims.”
  5. We aren’t the only ones who love inspirational quotes in our work space. Our meetings took place under Dr. Don Berwick’s familiar rallying cry for improvement.
  6. Twice a year, the BMC quality improvement team issues a call for improvement projects, receives about 20 proposals, and selects a handful to support directly. Quality improvement specialists meet with the front-line team to work on the project every week. Not quarterly. Not monthly. Every week.
  7. Improvement is boundariless. Ideas come from everyone, everywhere in the system. We heard about a wonderful improvement project involving housekeeping staff that, to call out one PDSA cycle, aimed to make sure trash baskets in patient rooms were never more than 3/4 full.
  8. A huge barrier to involving residents in quality improvement is their limited time with each unit. Projects last many months, but residents’ rotations last only a few weeks..
  9. At BMC, trainees spend a one-week rotation with the risk management department. Trainees are amazed at how much goes on behind the scenes, and many say the experience changes the way they practice medicine.
  10. BMC’s quality improvement specialists go beyond the Model for Improvement. They incorporate lean thinking, including a problem-solving tool called the A3.
  11. Patient care comes first. Clinicians are always busy responding to immediate needs, and they have to carve out time for quality improvement work. Being improvement people, we often forget it’s their other job.

Many thanks to Dr. Moses and all our friends at BMC for hosting us.

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