P4A158: Ispot an Improvement: Increasing and Standardizing Peer Observation and Feedback in PHM Teams (An American Academy of Pediatrics Maintenance of Certification Part 4 Project)

Purpose/Objectives:

Purpose: Peer observation and feedback (POF) allows clinicians to observe, learn from each other, and obtain concrete strategies for improvement. In a 2019 national study of pediatric hospitalists, 60% had experienced POF but most had no division expectation to participate. Participants endorsed a desire for POF in their practice setting and found it valuable for faculty development, however formal structure was lacking. This was the basis for creating iSPOT: Improving and Standardizing Peer Observation in PHM Teams.

Objective: Global

Aim: Formalize, standardize, and normalize POF in Pediatric Hospital Medicine (PHM). SMART

Aim: Increase POF events by 20% from baseline, or if starting from zero, to include 20% of the members of the practice group.

Design/Methods: This national quality improvement study is AAP MOC4 sponsored and IRB approved. A baseline number of POF events was obtained from each site. A key driver diagram was created and shared with participants (figure 1). Participants joined institutional POF efforts, submitted personal improvement goals, and attended quarterly webinars during which QI education was provided, data were reviewed, and plans for improvement activities were made. Site leaders collected data and implemented interventions to increase POF events. Characteristics of exemplary sites were shared. Baseline and quarterly data for 12 months were depicted using run charts (figure 2). Outcome measures were number of POF events, participant self-reported satisfaction in their clinical role, confidence in feedback, percent participation at each site, collegiality, and attainment of individualized goals. Process measures included number of participating sites with access to a tool for POF and percent participants at each site. The balancing measure was time spent in POF.

Results: Twenty-one sites enrolled. Figure 2 represents the total number of POF events during the study compared to the 1-year baseline of all sites. The number of POF events nearly tripled (increased 191% from baseline) by Quarter 4. Eighteen of 21 sites achieved the SMART enrollment aim, one site did not complete all observations, and 2 sites dropped out. Participant follow-up data will be collected 6 months after the end of Quarter 4 (6/2023). Preliminary participant feedback included perceived benefit to POF with respect to individualized goals and collegiality. Ongoing challenges with the COVID-19 pandemic and time constraints were identified as barriers.

Conclusion/Discussion: Creation of a national MOC program provided incentive and infrastructure to increase POF across diverse institutions. There was variability in percent participation by site. Next steps include expansion to other settings and collaboration with disciplines outside of PHM.