The American Board of Pediatrics: Efforts in Patient Safety and Maintenance of Certification Wednesd

1
The American Board of PediatricsEfforts in
Patient Safety and Maintenance of
CertificationWednesday, December 5, 20071200
100 p.m. EST
2

• Moderator
• Marlene R. Miller, MD, MSc, FAAP
• Vice President, Quality
• National Association of Childrens Hospitals and
  Related Institutions (NACHRI)
• Alexandria, Virginia

3
This activity was funded through an educational
grant from the Physicians Foundation for Health
Systems Excellence.
4
Disclosure of Financial Relationships and
Resolution of Conflicts of Interest for AAP CME
Activities Grid

• The AAP CME program aims to develop, maintain,
  and increase the competency, skills, and
  professional performance of pediatric healthcare
  professionals by providing high quality,
  relevant, accessible and cost-effective
  educational experiences. The AAP CME program
  provides activities to meet the participants
  identified education needs and to support their
  lifelong learning towards a goal of improving
  care for children and families (AAP CME Program
  Mission Statement, August 2004).
• The AAP recognizes that there are a variety of
  financial relationships between individuals and
  commercial interests that require review to
  identify possible conflicts of interest in a CME
  activity. The AAP Policy on Disclosure of
  Financial Relationships and Resolution of
  Conflicts of Interest for AAP CME Activities is
  designed to ensure quality, objective, balanced,
  and scientifically rigorous AAP CME activities by
  identifying and resolving all potential conflicts
  of interest prior to the confirmation of service
  of those in a position to influence and/or
  control CME content. The AAP has taken steps to
  resolve any potential conflicts of interest.
• All AAP CME activities will strictly adhere to
  the 2004 Updated Accreditation Council for
  Continuing Medical Education (ACCME) Standards
  for Commercial Support Standards to Ensure the
  Independence of CME Activities. In accordance
  with these Standards, the following decisions
  will be made free of the control of a commercial
  interest identification of CME needs,
  determination of educational objectives,
  selection and presentation of content, selection
  of all persons and organizations that will be in
  a position to control the content, selection of
  educational methods, and evaluation of the CME
  activity.
• The purpose of this policy is to ensure all
  potential conflicts of interest are identified
  and mechanisms to resolve them prior to the CME
  activity are implemented in ways that are
  consistent with the public good. The AAP is
  committed to providing learners with commercially
  unbiased CME activities.

5
DISCLOSURES
6
DISCLOSURES
7
DISCLOSURES
8
CME CREDIT

• The American Academy of Pediatrics (AAP) is
  accredited by the Accreditation Council for
  Continuing Medical Education to provide
  continuing medical education for physicians.
•  
• The AAP designates this educational activity for
  a maximum of 1.0 AMA PRA Category 1 Credit.
  Physicians should only claim credit commensurate
  with the extent of their participation in the
  activity.
•  
• This activity is acceptable for up to 1.0 AAP
  credit. This credit can be applied toward the
  AAP CME/CPD Award available to Fellows and
  Candidate Fellows of the American Academy of
  Pediatrics.

9
OTHER CREDIT

• This webinar is approved by the National
  Association of Pediatric Nurse Practitioners
  (NAPNAP) for 1.2 NAPNAP contact hours of which
  0.0 contain pharmacology (Rx) content. The AAP
  is designated as Agency 17. Upon completion of
  the program, each participant desiring NAPNAP
  contact hours should send a completed certificate
  of attendance, along with the required recording
  fee (10 for NAPNAP members, 15 for nonmembers),
  to the NAPNAP National Office at 20 Brace Road,
  Suite 200, Cherry Hill, NJ 08034-2633.
•  
• The American Academy of Physician Assistants
  accepts AMA PRA Category 1 Credit(s)TM from
  organizations accredited by the ACCME.

10

• Paul V. Miles, MD, FAAP
• Vice President
• Director of Quality and Practice Assessment
• The American Board of Pediatrics
• Chapel Hill, North Carolina

11
Learning Objectives

• Upon completion of this activity, you will be
  able to
• Discuss the role of the American Board of
  Pediatrics (ABP) in improving childrens health
  care quality and safety.
• Apply the new Maintenance of Certification
  process to your own individual situation.
• Describe the role of the ABP in specific projects
  to improve knowledge and delivery of safe care to
  children.

12
Patient Safety as a Professional Competency

• The American Board of Pediatrics Efforts in
  Patient Safety and Maintenance of Certification
• Safer Health Care for Kids Webinar
• Dec 5, 2007
• Paul V. Miles MDVice President for Quality and
  Practice Assessment
• American Board of Pediatrics

13
To Err is Human The IOM recommended that
standards for provider competence and
knowledge of patient safety be developed and
that assessment and reassessment on a periodic
basis be done.
14
The ability to assess and systematically improve
the safety of medical practice is an essential
competency of every certified physician.
..ABMS-CMSS Joint Planning Committee, December
2002
15
Six Core Physician Competencies Applied to
Patient Safety

• Patient care
• Medical knowledge
• Interpersonal and communication skills
• Professionalism
• Practice-based learning and improvement
• Systems-based practice

(Adopted by the ACGME and all twenty four ABMS
specialty boards)
16
Person Approach vs. System Approach

• Naturally enough, the associated
  countermeasures are directed mainly at reducing
  unwanted variability in human behavior. These
  methods include poster campaigns that appeal to
  people's sense of fear, writing another procedure
  (or adding to existing ones), disciplinary
  measures, threat of litigation, retraining,
  naming, blaming, and shaming. Followers of this
  approach tend to treat errors as moral issues,
  assuming that bad things happen to bad people
  what psychologists have called the just world
  hypothesis.1

Reason, J BMJ 2000320768-770 ( 18 March )
17
Person Approach vs. System Approach

• The basic premise in the system approach is
  that humans are fallible and errors are to be
  expected, even in the best organizations. Errors
  are seen as consequences rather than causes,
  having their origins not so much in the
  perversity of human nature as in "upstream"
  systemic factors.

Reason, J BMJ 2000320768-770 ( 18 March )
18
Dreyfus Model for Learning

• Novice
• Advanced beginner
• Competent
• Proficient
• Expert

19
Medical Career Continuum

• NoviceMedical student
• Advanced beginner.Beginning resident
• Competent..Senior resident
• Proficient.7-10 years into career
• Expert.......Senior faculty/practitioner

20
Improvement Focus
Educational System Improvement
Number of Pediatricians
Residents Faculty
Standard
Novice Competent - Expert
21
Team and System Competency

• The same progression from novice to expert
  applies to teams and microsystems
• The ABP will accept team data for certification
  of individuals

22
Personal Competency and Quality Care
J. Bingham D. Quinn Vanderbilt
23
Personal Competency and Patient Safety
24
Competency in Teamwork

• Team Knowledge
• Knowledge about components of teamwork
• Shared models
• Knowledge of teammate characteristics
• Knowledge of team mission, norms, objectives, and
  resources
• Task-specific responsibilities

Baker et al J Comm J Qual Patient Saf 31185-202,
Apr. 2005
25
Competency in Teamwork

• Skills
• Closed-loop communication
• Team leadership
• Mutual performance monitoring
• Backup behavior
• Adaptability
• Attitudes
• Belief in the importance of teamwork
• Mutual trust
• Team orientation

Baker et al J Comm J Qual Patient Saf 31185-202,
Apr. 2005
26
Measurement of Team Performance

• Must be grounded in team theory
• Must account for individual and team-level
  performance
• Must capture team process and outcomes
• Must adhere to accepted standards for reliability
  and validity
• Must address and real or perceived barriers to
  measurement

Baker et al J Comm J Qual Patient Saf 31185-202,
Apr. 2005
27
ABP Maintenance of Certification Version 1.1
Requirements

• Part 1 License
• Part 2 Knowledge Decision Skills SA
• Part 3 Secure examination
• Part 4 Component A Patient Survey
• Component B Approved activity

28
Version 1.1 How much time?
7-year certificate
NOTE Approximate times are actual seat time
and do not include preparation time
29
What is Part 4?

• Component A
• Patient Survey

• Component B
• Option 1 Approved web-based module
• AAP eQIPP modules
• Patient Safety module
• PIM module self-assessment combination package
• eg. Asthma PIM QI Self-assessment
• Option 2 Approved collaborative
• eg. VON project QI Self-assessment

Note Activities listed under the Component B
options are for example purposes only other
activities exist.
30
A Proposal to Design, Develop, and Deploy
aWeb-based Patient Safety Education and
Improvement Module That Will Meet the
Requirements for Part 4 Maintenance of
Certification TM
31
A Collaborative Effort

• ABMS lead organization
• ABP/AAP
• ABFP/AAFP
• ABIM/ACP
• Surgery, anesthesiology, other specialties
• VA, DoD, AHRQ,
• National experts on patient safety

32
Features

• Designed to work for all 650,000 board certified
  physicians across 24 specialties
• Designed to work for non practicing physicians
• Before and after knowledge self assessment
• Quality improvement approach
• Designed to work with local improvement efforts
• Hot Links to key Patient Safety Web sites

33
www.abms.org
34
www.abms.org
35
ABMS Patient Safety Improvement Program
www.abms.org
36
Other ABP Safety Initiatives

• Patient safety content in certifying exams and
  other parts of the certifying process
• ABP approval of patient safety improvement
  projects to meet the requirements for MOC Part 4
• Alliance for Pediatric Quality has selected
  patient safety as one of the three initial
  Improve First initiatives

37
Eliminating Bloodstream Infections
NACHRI CA-BSI Collaborative
In the first 6 months, 29 childrens
hospitals reduced infection ratesin the PICU by
nearly 70 percent by adhering to a rigid set of
evidence-based practices shown to prevent
infections in children.
70 improvement estimated 20 lives saved, 160
infections prevented,
6.4 million not spent in the first 6 months
38
Resources for Patient Safety

• AHRQ Web MM site www.ahrq.gov
• To Error is Human IOM
• Creating systems of safe care IOM
• To Do No Harm Julie Morath
• ABMS Web-based patient safety module

39
Now What?!?Some take-away points from the
Webinar

• The ABMS Patient Safety Program is valuable for
  all physicians
• Participate in a local, regional or national
  safety improvement project
• Engage in the AAP Safer Health Care for Kids
  effort
• Create a culture of safety in your practice
• Maintain board certification