November 12, 2004

Healthcare Matrix giving residents clinical ‘blueprint’

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Lynette Gillis, M.D.

Healthcare Matrix giving residents clinical ‘blueprint’

VUMC's Healthcare Matrix is getting national attention as a tool for teaching the new Accreditation Council of Graduate Medical Education (ACGME) core competencies to residents in a way that mirrors what they do as clinicians.

The Healthcare Matrix links education to the outcomes of care by combining the Institute of Medicine's (IOM) Aims for Improvement with the Core Competencies identified by the ACGME. The end result is a new type of blueprint for evaluating and learning from each patient.

“It's not just a theoretical system,” said John W. Bingham, M.H.A., director of the Center for Clinical Improvement, and creator of the Healthcare Matrix, “but one that directly applies to education and the delivery of care.”

The IOM has identified six areas of health care that call for improvement: safety, effectiveness, patient-centeredness, timeliness, efficiency and equity. Bingham took these areas of improvement and began looking for the driving force behind them. He determined it was the ACGME core competencies: patient-centered care, medical knowledge, interpersonal and communication skills, professionalism, systems-based practice and practice-based learning and improvement. When these competencies are met, patient care meets the six goals defined by the IOM, Bingham said.

Working with Doris Quinn, Ph.D., assistant professor of Medical Education and director of Improvement Education, Bingham refined the Matrix and Quinn began piloting the tool with residents.

The system allows a clinician to look at an episode of care and determine how the quality of care was affected by the core competencies. Using the Matrix, a clinician is able to rate the episode based on the six aims. For example, was the care safe? If not, was there a breakdown in any of the areas of competency such as medical knowledge, professionalism, communication, or system issues? And finally, how could it be improved in the future?

When the Matrix is completed, the clinician should have an understanding of the level of care delivered to the patient, why — if any — less than optimal care was delivered, and how care can be improved in the future.

“The Healthcare Matrix is a very unique and creative system, and it really enables us to bring these important competencies directly into our educational programs,” said Steven G. Gabbe, M.D., dean of the School of Medicine.

One highlight of the Matrix is its versatility, Quinn said.

“The Matrix can be used by an individual resident, as a case presentation in a group process, or it could be used for a panel of patients,” she said. “The Matrix can be used across all disciplines to help make clinicians more aware of issues that surface in everyday care.”

So far, the Healthcare Matrix is being piloted in many specialties, including Anesthesiology, Emergency Medicine, Psychiatry, Internal Medicine — Ambulatory Care, General Pediatrics, and others. It is also being used to transform traditional Morbidity and Mortality (M&M) conferences into Morbidity and Mortality and Improvement conferences.

This week, Bingham and Quinn will present a storyboard on the Matrix as part of "Innovations Medical Education" at the Association of American Medical Colleges conference in Boston. They were also speakers at a plenary session, addressing the linkage of core competencies to outcomes of care using the Matrix.

Since half the Matrix — the ACGME Core Competencies — is a mandatory aspect of an accredited residency program, Quinn says the tool can help residency program directors be certain they're being addressed.

For more information on the Healthcare Matrix, please e-mail Quinn at