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Class 6 Team 2 assignment

Page history last edited by ptanaka@stanford.edu 8 years, 11 months ago

ACMD 512 Class 6 Team 2 response


Ahmad Alawadhi; Dante Cerza; Mitzi D’Aquila; Pedro Tanaka


Assignment #6: Systems based practice is far reaching and diverse. As you know, the Patient Protection and Affordable Care Act (Health care reform) requests a number of assessments of community health needs, there is also the Medical home, the ACOs, ICD 10 coding, etc.

If you could pick one initiative that is key for your learners to know about and consider, what is it, and why did you choose it? How would you teach it to them and assess the outcomes?





The initiative we chose is the Institute of Healthcare Improvement (IHI) Improvement Map.  The IHI provides this map as one of the Strategic Initiatives proposed for improvement in medical care.  It is an educational initiative and serves as a readily available on-line resource for health care practitioners. 


The IHI Improvement Map covers dozens of important topics pertaining to health care and systems of care. Each topic addresses one or more aims of health care as defined by the IOM (effective, efficient, equitable, patient-centered, safe, and timely).  These aims fit in with the spirit of systems-based practice (SBP) and thus serve as an approach to learning about SBP.   The topics also fit into one of the following domains that are relevant to SBP: leadership/management processes, patient care processes, and processes to support patient care.


The IHI Improvement Map outlines a strategy for implementing patient care improvement processes by three domains, or by the aim to be affected by change. Each domain includes a module for understanding the reasons or requirements for process change, estimated cost, time, difficulty, and level of evidence to support change processes, and links for further learning.


i.  Leadership/management processes: How to set aims for organizational improvement based on mission, vision, and current performance, through a partnership that involves those persons who are most involved in the related patient care work.



ii.  Patient Care processes: 34 processes related to high quality patient care for individuals, based on specific content areas, including:

     Acute delirium

     Acute myocardial infarction

     Acute respiratory distress syndrome prevention and management

     Advance care planning

     Cancer care in the hospital

     Catheter-associated urinary tract infection prevention

     Central line bundle

     Communication with patients and families after adverse events

     Community acquired pneumonia core processes

     Disease-specific care for common comorbidities

     Emergency department reliable care

     Glycemic control in critical care

     Heart failure core processes

     High-alert medication safety

     Neonatal intensive care unit standard care

     Pain management

     Palliative care

     Pediatric common conditions

     Percutaneous coronary intervention

     Perinatal elective induction safety

     Perinatal labor augmentation safety

     Positive patient experience

     Pre-operative patient assessment

     Pressure ulcer prevention

     Rapid response systems

     Sepsis detection and management

     Shared decision making

     Stroke management

     Surgical complications core processes

     Venous thromboembolism prevention and treatment

     Ventilator bundle

     Well newborn care 


iii.  Processes to support patient care: 24 processes that support quality care change through a systems approach, including:

     Antibiotic stewardship

     Communication and teamwork

     Critical results reporting

     Daily goal setting and planning

     Early warning signs

     Efficient and reliable transportation systems

     Emergency department timeliness

     Fall prevention

     Hand hygiene

     Infection prevention

     Laboratory testing and reporting

     Medication administration

     Medication ordering

     Medication reconciliation

     Multi-disciplinary rounding

     Nutrition care services

     Patient flow for efficiency and safety

     Patient transitions and handoffs

     Pharmacy safety and reliability

     Radiology testing and reporting

     Simulation for high-risk situations

     Standard precautions

     Surgical checklist

     Transitioning out of the hospital


iv.  By Aim: Content topics are mapped to a number of aims for process change, including:

     Effective: evidence-based practice to produce better patient outcomes

     Efficient: appropriate use of resources at the least expense to patients and systems

     Equitable: care delivered fairly with consideration to need

     Patient-centered care

     Safe patient care

     Timely patient care








  1. Understand aspects and ramifications of SBP.
  2. Apply principles of SBP into different specialty practices.
  3. Introduce students to a resource for integration of principles of SBP into future practice, learning activities and system improvement efforts.





Third-year medical students completing their core clinical clerkships will be introduced to principles of SBP and to the IHI Improvement Map. During each clerkship rotation, the student will select one process relevant to the specialty and will compare the practice and activity of the system in that area (clinic, hospital, group practice, etc.) to the standards set forth in the modules.






At the end of this learning module students will be able to:


  1. Describe important components of SBP.
  2. Explain how SBP is important to health care practitioners.
  3. Apply principles of SBP into clinical learning experiences.
  4. Utilize an online resource for SBP.
  5. Evaluate practices and systems of health care based on proposed standards and recommended best practices set forth in the Improvement Map.





  1. Pre-assignment reading:


Johnson J, Miller S, Horowitz S. Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work.



  1. On-line independent study:


Institute of Healthcare Improvement Map (http://app.ihi.org/imap/tool/)



  1. Lecture (one hour, at the beginning of the third year):


Introduction to the principles and goals of SBP

Introduction to resources for SBP, including the IHI Improvement Map

Description of the independent learning activity integrated into clerkship rotations


  1. Student assessment of practices and systems


The student will select a module that is provided by the IHI on its Improvement Map. He/she will observe practices and activities in the system in which he/she rotates.  For example, he/she will observe the hospital system’s activity in the area the student selected during his/her inpatient internal medicine rotation.   At the end of the rotation, the student will write a reflection in which he/she compares the practice he/she observed with the recommended practice or the ideals set forth by the IHI.  Six reflections will comprise the entire SBP portfolio for this activity.


Guidelines for module selection:


    1. The topic must be relevant to the specialty in which he/she is rotating. 
    2. By the end of the rotation, the topics selected must cover all the all 6 aims and the 3 domains.






  1. Peer assessment: each student’s portfolio will be read and critiqued by one classmate.
  2. Assessment by faculty:  one faculty will read and critique each portfolio.








Survey of the students on their comfort with assessing systems of care at the end of third year.






  1. Johnson J, Miller S, Horowitz S. Systems-based practice: Improving the safety and quality of patient care by recognizing and improving the systems in which we work. http://www.ahrq.gov/downloads/pub/advances2/vol2/Advances-Johnson_90.pdf
  2. Institute of Healthcare Improvement Map (http://app.ihi.org/imap/tool/)

Comments (1)

Bev Wood said

at 5:51 am on Feb 15, 2012

The IHI is a wonderful source for information, ideas, and guidance. Thank you for developing something based on their improvement map and for your very nice elucidation of the purpose and intent of SBP. This is often a forgotten, but very important part of medical practice, and you have developed it into a worthwhile teaching and learning exercise.
The students will benefit greatly from the review of the student portfolio and from developing one pertinent aspect of the Improvement Map. The development you describe should also carry over well into practice.

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