4 lessons for physicians to successfully lead value improvement teams

Family medicine residents who complete training at the University of Utah are coming away with the skills they need to lead value improvement efforts in their first year of practice.

The university’s family medicine residency program designed a three-year experience to prepare its doctors for the real work of improving clinical practice by leading value improvement efforts, write a team from the University of Utah Health in NEJM Catalyst.

While physicians are increasingly expected to lead improvement teams, there’s little formal guidance on what skills they need to succeed at the task.

To develop skills during training so they are ready to lead, the residents are tasked with working with a team located in the clinic where they practice to improve a publicly reported quality metric, the residency program leaders said.

Although the residents initially chose topics they were interested in, starting in 2015 the residency program began assigning topics based on institutional priorities. The residents lead improvement efforts on a publicly reported quality measure, such as a disease-management metric, immunization rate or screening-guideline adherence.

As part of a team, the residents work with faculty, other residents, medical assistants, physician assistants, pharmacists, nurses and psychologists. While they start out carrying out delegated tasks, in their third year, residents lead the teams with faculty supervision.

Working on an interprofessional team and following quality improvement methods taught residents four lessons, according to residency program leaders:

1. The importance of conducting a baseline analysis before diving into an improvement project.

2. Teams with diverse roles, such as medical assistants, nurses and clerical staff, design better solutions than a lone doctor.

3. Leadership skills are necessary to influence the practice of other people, including effective communication and team activation.

4. The importance of maintaining a clear focus on a strategic clinical goal.