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Academic medical centers strive to achieve the dual goals
of providing outstanding clinical care today and producing
the outstanding clinicians of tomorrow. To achieve these dual
goals for integrated quality of clinical care and educational
excellence requires five key organizational components. The
TEAMS model on the left depicts the integration of these factors:
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A strategic commitment to the core principles of safety
and quality. The Institute of Medicine's landmark
report, Crossing the Quality Chasm, describes a
high quality health care system as one that delivers safe,
timely, effective, efficient, equitable, and patient-centered
care.
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Formal quality improvement education across
the medical education continuum. This includes didactic
as well as practical training at the undergraduate, graduate
and continuing medical education levels. QI must be taught
across the continuum in order to reinforce and promote
application of these core principles in clinical practice.
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Team and behavioral competence training. Root
causes of medical error and patient dissatisfaction are
often attributed to deficiencies in behavioral competence.
Interdisciplinary team training and behavioral competence
training for clinicians (e.g. how to be a good leader,
a good follower, a good communicator, and an effective
team member) contribute to enhanced quality of clinical
care.
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Ongoing assessment and data analysis. National
databases and benchmarking tools, such as Hospital Compare
and the Dartmouth Atlas, provide metrics for measuring
and assessing clinical outcomes data. As a result of increased
focus on quality measures and outcomes, several states
and hospitals have also begun to publish their own quality
data and scorecards.
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Continuous clinical and organizational performance
improvement activities. Examples of clinical QI activities
include the use of tools like checklists and implementation
of health information technology, such as computerized
physician order entry. Organizational PI tools include
Six Sigma strategies, Toyota Lean approaches, and Crew
Resource Management training.
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