Residents Are Helping Improve Quality and Safety, One Project at a Time

By Susan Gallagher

Two residents present their quality improvement project.We’ve all been there many times: we notice something in our work environment that just isn’t functioning quite right. All too often, we simply accept these circumstances as inevitable challenges, complain about them occasionally and go about our work. 

Duke psychiatry residents, on the other hand, are rolling up their sleeves and digging deeper to learn more about some of the problems they identify around them and collaboratively devise solutions with their peers, care teams and faculty mentors. Since 2013, they’ve been applying evidence-based quality improvement approaches to affect positive, lasting changes in the clinical environment and educational programming. 

About five years ago, training in quality improvement strategy was formally embedded in the residency curriculum as part of an initiative led by associate professor Jane Gagliardi, MD, MHS, then the psychiatry residency program director. The curriculum is based on materials from the Association of American Medical Colleges and the Institute for Healthcare Improvement. In the six months following the course, residents are required to identify and complete at least one “Plan, Do, Study, Act” (PDSA) cycle toward a quality improvement project. Many develop new projects, while others build on previous resident initiatives; some residents go on to complete multiple PDSA cycles.

Gagliardi’s goal has been to provide real-world lessons in how to effectively change systems. “While many of these projects have been extraordinarily successful, some do fail, and that’s okay,” she says. “It’s a learning process—that’s why we start small.” She notes that lessons about project selection and stakeholder involvement are best learned through first-hand, real-life experiences, hence the requirement that residents select and design their own projects.

Training in patient safety and quality improvement is among the Accreditation Council for Graduate Medical Education requirements for all GME trainees, but Duke’s psychiatry residency program’s curriculum is unique in requiring the projects to be resident-identified and resident-driven. Residents have the opportunity to bring about real change in the program and in the clinics and hospitals where they spend their time and observe “low-hanging fruit” that, if changed, could result in meaningful impact on patients and the system.

Here are just a few examples of the patient safety and quality improvement projects residents have undertaken this year: 

  • Drs. Alexandra Bey, Jonathan Komisar and Hira Silat, with faculty mentor Kristen Shirey, MD, are working to improve care for hospitalized adults with neurodevelopmental disorders at Duke University Hospital.   
  • Drs. Hira Silat and Hiba Zaidi, with faculty mentor Marla Wald, MD, are working to improve the quality of care for perinatal psychiatry patients through education and patient care interventions.
  • Dr. Elizabeth Hoffman, with faculty mentor Sandra Brown, MD, is developing strategies to improve engagement across the multidisciplinary care team in the Duke University Hospital psychiatric inpatient unit. 

PGY3 resident Hira Silat, MD, has been involved with several quality improvement projects during her time in the program. She says that engaging in the quality improvement process is not only fun—she enjoys the innovation and creativity—but also empowering and valuable for trainees.

“These projects help us understand the process of bringing about change in a healthcare or educational system,” she says. “And it can help residents develop the advocacy and communication skills required to collaborate with multiple stakeholders, which are important skills for a career in psychiatry.”