As an intern with The Ohio State (OSU) University College of Medicine, Iahn Gonsenhauser, MD, MBA, worked on a project to develop a sustainable process for measuring the quality of robotic surgery across multiple disciplines. The project was supported by the department of quality improvement and operations at OSU’s Wexner Medical Center. The study delivered an actionable and reproducible framework for robotic surgery quality measurement, but that’s not all. Bolstered by the work, Gonsenhauser turned his experience into a series of quality-focused educational initiatives for students and residents, filling the gap in quality-centered learning for those whose curriculum failed to cover it.
“As a student, I could see that quality research and methodology skills were starting to become desired and expected of me and my peers as future clinicians,” Gonsenhauser says. “But the opportunities to engage in it as a student were pretty slim.” In response, Gonsenhauser created an Institute for Healthcare Improvement (IHI) student group. The group’s purpose was twofold – to create opportunities to educate themselves and to generate research that the hospital could actually use. For example, one of their first projects was to pose as students interested in shadowing surgery while they covertly audited surgeons’ use of quality protocols. “Open audits weren’t providing enough insight,” Gonsenhauser says, “so we were able to provide that information to the hospital while at the same time educating ourselves on quality procedures in surgery.”
The group also helped bolster the hospital’s data collection by employing the student body to collect data around process improvement. “We had about 1,000 students, most of whom were interested in doing research of one kind or another,” Gonsenhauser says. The group also worked closely with IHI to set up an Open School chapter, attend national conferences and engage with the institute on a regular basis.
As Gonsenhauser’s career progressed, he continued to view his training with the same critical eye, finding that the natural next step was to apply the same principle to residents. “As an MBA, I’ve always been interested in organizational behavior,” he says. “In surveying the residency program, I could see that many of us had never been educated in the principles that are becoming integral to health care – quality improvement, methodology, process improvement, lean techniques. These are curriculum requirements for the students who are coming up behind us, but they weren’t part of our education.”
Taking an idea from an Association of American Medical Colleges (AAMC) conference, Gonsenhauser began to develop a formal resident quality committee. He worked with other interested residents to develop a structure and charter, and then put the idea in front of the program director of the graduate medical education office and the resident leadership committee. Gonsenhauser knew that he needed to appeal to diverse interests in order to get buy-in from both management and his fellow residents. “You have to appeal to their bottom line,” he says. “As trainees, our bottom line is education and career development, which is very different from management’s bottom line, which is driven by outcomes, cost and patient satisfaction.”
Helping him find that bottom line in each of his endeavors has been Susan Moffatt-Bruce, MD, PhD, chief quality and patient safety officer at OSU’s Wexner Medical Center as well as an associate professor of surgery at OSU. “Dr. Moffatt-Bruce has been instrumental in all of this from the get-go,” Gonsenhauser says. “She is committed not only to institutional quality improvement but to academic and educational improvement as well.” Whether it was providing an assessment product for the robotic surgeons or advancing education and networking opportunities through the IHI student group, Moffatt-Bruce helped Gonsenhauser find the key to each stakeholder’s need. “She is exceptionally skilled at aligning people’s interests and generating something that satisfies everyone’s wants,” Gonsenhauser says. “She has been the key to getting all of these projects up and moving.”
And now that the resident quality committee is up and moving, education and quality projects are the focus. The group regularly hosts staff or faculty who speak on quality-related topics. “Initially we’re going to require a fair amount of outside education to bring ourselves up to speed,” Gonsenhauser explains. “Eventually we should be fairly self-sustaining and can educate each other as well as our co-residents in our respective departments.”
The committee is also focusing on the discharge and readmission processes through a narrow lens, concentrating on issues that occur on discharge from any unit to one of OSU’s physical medicine and rehabilitation hospitals, as well as potential readmission from that unit. Individual topics in this area include capacity management, readmission rates and patient satisfaction.
Finally, the committee is keeping abreast of newly created hospital policy, the impetus for which also came from the AAMC conference. “I saw how the implementation of a house staff quality forum put the policy generated at the institutional level in front of the front-line providers,” he explains. “I saw the potential benefit of front-line feedback on the effectiveness of policy implementation.” To this end, Gonsenhauser sits on the hospital leadership council, clinical quality and patient safety committee, and physician evaluation committee. “I try to take the issues on the radar of senior executives and put those things in front of the residents, to stay aware of the current focus and priorities for the organization,” he says.
Gonsenhauser believes that his committee can help create transparency in both directions – from top to bottom and vice versa. “We’re recognizing issues on the front line and can bring projects and ideas to management while also being aware of their priorities and policies. In this way, as an organization we can generate policy that’s going to be more effective, efficient and easier to keep in place, more sustainable,” he says.
While Gonsenhauser admits that the committee is still young, he hopes to continue to integrate it into the hospital quality hierarchy, ultimately reaching a point of parallel policy generation from the top and resident level. He also wants to create more diversity among the group itself, which currently comprises mostly medical residents in a number of different specialties, and is working on branching out into nursing, masters of health administration students and OSU fellows. “We are going to be the agents of change in health care,” Gonsenhauser notes, and quality will be a necessary part of that role.
For more information on the resident quality committee at OSU, please contact:
Iahn Gonsenhauser, MD, MBA
Wexner Medical Center
The Ohio State University College of Medicine