Chiefs leading a tradition of quality

The United States Veterans Affairs National Center for Patient Safety is working to revise and improve its VA Chief Residents in Quality and Patient Safety (CRQS) program and Iowa has a seat at the national table. Matthew D. Soltys, MD, clinical assistant professor in General Internal Medicine and Iowa’s 2020–21 Chief Resident in Quality and Patient Safety, was invited to work alongside other patient safety experts from across the country to expand and revise the national curriculum.

The CRQS program is a highly prestigious, one-year position that offers chief residents access to a robust national curriculum and a specialized local curriculum. As one of the largest and oldest quality improvement programs in the US, the VA’s CRQS program trains residents to prioritize safe, efficient, and patient-centered care. There are currently more than 110 CRQS positions at nearly 60 VAMCs nationwide.

“I want the curriculum for the CRQS to be the most robust quality improvement and patient safety curriculum in the US,” Soltys said. He hopes that he can help improve the curriculum and that current chiefs and alumni of the program can be leaders in the health care community. “The curriculum redesign is to keep up with the evolving field of quality improvement and patient safety. Everyone wants to make sure these chiefs get the latest training and have hands-on experience in improving health care.”

Soltys has mentored both of the chief residents who succeeded him in the role and served as a “den leader” at the Iowa City VA medical center even before taking on this new role with the VA National Center for Patient Safety.

“This new curriculum uses concepts like Zero Harm, the High Reliability Organization, and Just Culture to show the chief residents what it takes to effect sustained positive change in a healthcare organization. The CRQS program is growing, and they need more leaders to teach chiefs,” Soltys said. “It’s been amazing. Chief residents are usually really motivated, and I get to mentor them. It’s a great opportunity.”

The Iowa City VA’s CRQS program began in 2015 and has successfully recruited a CRQS every year. Seven CRQS have completed the program, Samuel Zetumer, MD, is currently serving for 2022–23, and, Kathie Zhang, MD, has already been selected for 2023–24.

Krista Johnson, MD, MME, clinical professor in General Internal Medicine and associate program director of the Internal Medicine Residency Program, serves as the lead CRQS mentor and site director. “All our CRQS have been very dedicated to their role, and each has had their unique impact on the teaching, curriculum development, scholarship, and improvements in quality and patient safety at the Iowa City VA,” Johnson said. “They have all had a huge impact on the education of our residents in quality and safety and are a wonderful resource for our program. We recently reapplied for the recompete request for proposals and were awarded an ongoing Internal Medicine CRQS based on the success of our program and hard work of our former CRQS.”

Soltys sounded similar notes when assessing the impact on Iowa’s residents. “Here at Iowa City, I would say we have a very advanced local curriculum for our CRQS. I think it’s a unique position where they get thrown into multiple leadership positions early on, where they’re both a leader and a learner,” Soltys said. “Everyone who’s done this role has really succeeded in what they want their professional career to be.”

With standing seats on the Code Blue Committee and the Medication Safety Subcommittee, Iowa CRQS residents get hands-on experience with healthcare leadership. CRQS residents have access to extensive mentorship and have presented at regional and national conferences. All seven Iowa CRQS residents have succeeded in their career aspirations and each has kept quality and safety prominent in their practice:

• Alexis Wickersham, MD (2015–16), is a clinical assistant professor and assistant program director of Internal Medicine Residency at Jefferson University.
• Carly Kuehn, MD (2016–17), is the Educational Director for Quality and Safety for Internal Medicine and a clinical assistant professor in General Internal Medicine at Iowa.
• Amanda Grippen Goddard, DO (2017–18), completed fellowship and is a practicing Allergist and Immunologist at a private practice in New Mexico.
• Jennifer Langstengel, MD (2018–19), is a Pulmonary and Critical Care fellow at Yale University.
• Brenden Boyle, MD (2019–20), is a Cardiology fellow at the University of Minnesota.
• Matthew D. Soltys, MD (2020–21), is a clinical assistant professor in General Internal Medicine at Iowa and a VA Quality Scholar.
• Derek Hupp, MD (2021–22), is a General Internist at Gundersen Health Systems in LaCrosse, Wisconsin

The impact each CRQS leaves behind on the program is unique and lasting but the reverse is also the case. As the 2021-22 CRQS, Derek Hupp, MD, gained invaluable leadership experience and mentorship. At Gundersen, Hupp says he will work with a community-based residency program where he will teach and lead their residents’ quality improvement curriculum.

“As the Iowa City VA CRQS, I’ve had the privilege to devote a year to learning and teaching quality improvement principles, gaining proficiency in Lean Six Sigma, understanding healthcare data to guide improvement, and evaluating medical errors from a systems-level perspective,” Hupp said.

Hupp has worked directly with mentors like Johnson and Soltys to become well-versed in quality improvement. As part of the robust local curriculum at the University of Iowa, Hupp completed a capstone project, which focused on improving the continuity of care for veterans discharging from the hospital and transitioning to appointments in outpatient clinic.

“I am fortunate to be able to continue working with and mentoring residents on QI projects and patient safety concepts as an attending in my next position, and I hope to build on my CRQS training to make a positive impact on my colleagues’ and patients’ lives in the years to come,” Hupp said.

The contributions each of these physicians has made to the role of the CRQS at Iowa has provided its current stewards a strong foundation to build on. The current CRQS, Samuel Zetumer, MD, specifically cited the work that Hupp has done in the Transitions of Care for veterans as inspirational. “It is difficult to overstate the importance of this clinic to our veteran patients,” Zetumer said. His training in mathematics and computer science finds him currently working on how to improve gathering and processing clinical data.

He is supported in this work by Carly Kuehn, MD, who, as noted above, succeeded Johnson as Educational Director for Quality and Safety. Kuehn not only serves as a mentor and sounding board for the CRQS but also helps guide all the residents in their QI projects. “My year spent as a Chief Resident of Quality and Safety inspired my career goals: teaching others about quality improvement and patient safety concepts. It is exciting to continue doing so here at Iowa while working with each year’s CRQS,” Kuehn said. “Each new chief brings a new flavor to the curriculum, as the CRQS is an integral part of the IM Resident Quality Education Program.”