Kaizen: A framework for implementing residency program improvements

In the fall of 1996, our general surgery residency began a kaizen - a Japanese word meaning "the relentless quest for better quality" - to improve our program. Using a consumer-oriented approach to program evaluation, our residents and faculty identified areas for improvement in conferences, rotations and services, and coordination of educational efforts at various hospital sites. A Kaizen Task Force, composed of residents, faculty, and administrators, considered these suggestions and made recommendations for change. We implemented the following recommendations. (1) Conferences: conferences were bundled (now there are 2 conference-free weekdays); mandatory conference time was emphasized; a new PGY1 problem-oriented conference was added; Grand Rounds and Morbidity and Mortality (M&M) conferences were restructured. (2) Rotations: services were renamed as teams with a "team education coordinator" appointed to each; expectations for each team were published; size of teams was decreased; mandatory ambulatory experiences were expanded for PGY2-5 residents. (3) Coordination at hospital sites: a research symposium was held; more visiting professors were invited; additional social events have been successful. Other additional improvements were implemented. A new resident performance evaluation system provides performance feedback at the midpoint and end of each 3-month rotation. There is increased scrutiny of resident work hours. More resources are allocated to support scholarly activities of residents (purchase of textbooks, surgical atlases, and magnifying loupes; purchase of upgrades for computer hardware and software in the resident library). These enhancements demonstrated the responsiveness of the program and the department to needs outlined by both residents and faculty.