Pursuing Excellence in Clinical Learning Environments Initiative

UCSF Health has defined “Establishing a Culture of Continuous Process Improvement” as one of its three major strategic priorities. To achieve this strategic priority, we have developed True North pillars that serve as a constant guide for aligning and prioritizing our work.  The six pillars are patient experience, quality and safety, our people, financial strength, strategic growth, and learning health system.

In 2016, UCSF was selected as one of eight institutions to participate in the ACGME Pursuing Excellence Program. To achieve the Pursuing Excellence aim, we have worked to ensure that all aspects of UCSF GME strategic priorities are fully aligned with the UCSF Health True North pillars. We have also focused our efforts to teach residents and fellows how they can improve quality, safety, equity, and value at UCSF Health. Most recently, we have developed an innovative faculty development program for physician faculty to ensure that we have expert educators capable of practicing, teaching, and assessing quality, safety, equity, and value.  We have also worked to share this learning across the health professions and to enhance our interprofessional clinical learning environment.

Currently, we are training cohorts of clinically active, non-physician improvement experts (predominantly nurses and pharmacists) who are explicitly trained in both advanced improvement science and in the effective teaching and coaching of these skills.  We will teach them how to effectively teach and coach residents and fellows, physician faculty, and other non-physician faculty, staff, and students. They will be identified as Lean Certified Learning Health System Coaches and be fully integrated into the existing and future cohorts of physician Lean Certified Learning Health System Coaches. They will work directly with residents and fellows to ensure that future improvement activities are fully interprofessional. The resident and fellow program is called REFLECT, Residents and Fellows Leading Interprofessional Continuous Improvement Teams. Learn more about REFLECT, please visit the REFLECT webpage.

UCSF residents and fellows currently work to achieve True North priorities both with all-program goals and program-specific goals. These goals are selected each year by UCSF Health leadership, UCSF GME leadership, and residents and fellows. Residents and fellows are coached and mentored in this work by a small number of expert faculty.  With our current faculty development effort to create a new, larger cohort of truly expert physician faculty (Lean Certified Learning Health System Coaches), we anticipate that the residents and fellows will be able to achieve deeper and more sustainable improvements in both the all-program goals and the program-specific goals.