Quality Improvement | Icahn School of Medicine

In keeping with the ambitious goals of the ACGME’s Clinical Learning Environment Review (CLER) Program , we seek to ensure that post-graduate training occurs in learning environments in which safety is optimized and trainees are regularly engaged in committees and initiatives that allow them to impact patient care and operational efficiency. We strive to achieve a culture of safety, where adverse events are reported and residents and fellows are involved in investigations and debriefs to learn from errors and adverse events. Below you will find some of the current activities and initiatives that are underway.

At the Icahn School of Medicine at Mount Sinai (ISMMS), we are committed to providing the educational opportunities for residents and fellows to gain the knowledge and skills necessary to become leaders in quality improvement and patient safety.

Clinical Learning Environment Review (CLER) Subcommittee

Chaired by Brijen J. Shah, MD and Daniel I. Steinberg, MD, and a working subcommittee of the ISMMS Graduate Medical Education Committee (GMEC), the CLER Subcommittee comprises GME leaders, faculty, and residents/fellows and works to meet the ACGME’s expectations for an optimal clinical learning environment to achieve safe and high quality patient care in the following domains:

• Patient safety reporting, education, and engagement, including the opportunity to participate in investigations and follow-up
• Professionalism education and engagement, including resident and faculty perceptions of professionalism and the establishment of effective policies and procedures for addressing concerns and reports of unprofessional behavior
• Quality improvement education and engagement in quality improvement activities and committees, including initiatives related to health care disparities
• Transitions of care education and engagement, including communications between consult teams and patient transfers between services and locations
• Supervision education and monitoring, including resident and faculty perceptions of adequacy and the roles of clinical staff members other than physicians

ACGME Health Care Disparities Pathway Collaborative

ISMMS was one of nine Sponsoring Institutions nationwide to be selected to participate in the ACGME’s Pathway Leaders Health Care Disparities Collaborative as part of the ACGME’s Pursuing Excellence in the Clinical Learning Environments Initiative. The selected project is “Use of granular race and ethnicity data (RED) and sexual orientation and gender identity (SOGI) data to assess ambulatory learning environment’s disparities in process and outcomes of health care.” 

The collaborative, which runs January 2019 to March 2020, brings together a diverse group of team members, including GME and Hospital leadership, residents/fellows, faculty, health informaticists, and nurses to explore and improve health care disparities in our community. This project and participation in this collaborative provide an opportunity for the larger ISMMS GME community to learn from others and be a leader in this area of quality

Root Cause Analysis

At The Mount Sinai Hospital, residents are invited to apply to participate on the Root Cause Analysis (RCA) Committee, which is part of the Serious Adverse Event Process for Patient Safety. Participating members of the RCA Committee are provided with orientation and training and are invited to attend 5-10 RCAs over the course of the academic year, providing input to case discussions and safety solution meetings.

Incident Reporting

Residents and fellows across ISMMS programs are encouraged to report incidents and near misses that may impact patient safety. At The Mount Sinai Hospital, this occurs in the online Medical Event Reporting System (MERS), and trainees are also encouraged to participate in the Great Catch Program, which encourages the reporting of near misses with monthly rewards for the “best” catch. At Mount Sinai Beth Israel, trainees utilize the Enhancing Safety Through Engagement and Reporting (ESTER), which was developed in late 2017 to allow for online reporting of errors, unsafe conditions, and serious adverse events.

GME Lean Training Program

This 20-hour training program is based at the Mount Sinai Morningside Lean Lab under the direction of Lucy Xenophon, MD, MPH, CMQ, Chief Transformation Officer at Mount Sinai Morningside, and is designed to promote resident/fellow engagement in quality improvement, providing residents, fellows, and faculty mentors with exposure to Lean management principles and their application to the improvement of health care processes and operations. Participants are asked to complete a quality improvement project during the course of the training, and upon completion are provided with Lean Bronze Belt Certification.