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Engaging Residents and Fellows to Improve Institution-Wide Quality: The First Six Years of a Novel Financial Incentive Program

Vidyarthi, Arpana R. MD; Green, Adrienne L. MD; Rosenbluth, Glenn MD; Baron, Robert B. MD, MS

doi: 10.1097/ACM.0000000000000159
Research Reports

Purpose Teaching hospitals strive to engage physicians in quality improvement (QI), and graduate medical education (GME) programs must promote trainee competence in systems-based practice (SBP). The authors developed a QI incentive program that engages residents and fellows, providing them with financial incentives to improve quality while simultaneously gaining SBP experience. In this study, they describe and evaluate success in meeting goals set during the program’s first six years.

Method During fiscal years (FYs) 2007–2012, QI project goals for all or specific training programs were set collaboratively with residents and fellows at the University of California, San Francisco (UCSF). Data were collected from administrative databases, via chart abstraction, or through independently designed techniques.

Results Approximately 5,275 residents and fellows were eligible and participated in the program. A total of 55 projects were completed. Among the 18 all-program projects, goals were achieved for 11 (61%) in three domains: patient satisfaction, quality/safety, and operation/utilization. Among the 37 program-specific projects, goals were achieved for 28 (76%) in four categories: patient-level interventions, enhanced communication, workflow improvements, and effective documentation. Residents and fellows earned an average of $800 in bonuses/FY for achieving these goals.

Conclusions Thousands of residents and fellows across disciplines participated in real-life, real-time QI during the program’s first six years. Participation provided an experience that may promote SBP competence and resulted in improved quality of care across the UCSF Medical Center. Similar programs may assist teaching hospitals and GME programs in meeting current and future QI and training mandates.

Dr. Vidyarthi is associate professor, Duke–National University of Singapore Graduate School of Medicine and consultant, SingHealth Pvt Ltd., Singapore. Formerly, she was associate professor of medicine and director of quality and safety programs, Office of Graduate Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California.

Dr. Green is professor, Division of Hospital Medicine, Department of Medicine, University of California, San Francisco, School of Medicine, San Francisco, California.

Dr. Rosenbluth is associate professor, Division of Hospital Medicine, Department of Pediatrics, and director of quality and safety programs, Office of Graduate Medical Education, University of California, San Francisco, School of Medicine, San Francisco, California.

Dr. Baron is professor, Division of General Internal Medicine, Department of Medicine, and associate dean of graduate medical education, University of California, San Francisco, School of Medicine, San Francisco, California.

Funding/Support: None reported.

Other disclosures: None reported.

Ethical approval: This study was reviewed by the chair of the UCSF Committee on Human Research and deemed exempt.

Previous presentations: A description of this program without results was previously presented at AAMC Integrating Quality, Chicago, Illinois, June 2009, and published in a response to the Academic Medicine 2011 Question of the Year (Acad Med. 2011;86:1338).

Supplemental digital content for this article is available at http://links.lww.com/ACADMED/A182.

Correspondence should be addressed to Dr. Vidyarthi, Duke–National University of Singapore Graduate School of Medicine, 8 College Rd., Singapore 169857; telephone: (+65) 9009-8011; e-mail: arpana.vidyarthi@duke-nus.edu.sg.

© 2014 by the Association of American Medical Colleges