Improvement management for academic medical centers

Academic medical centers run genuinely complex matrix structures. A cardiologist may report to the Department of Medicine, a heart institute and a cardiovascular service line at once, and improvement work needs to span all three. Tools built for simple hierarchies force a false choice between system-level standardization and departmental flexibility.

Improvement and research sit side by side. Projects often live at the boundary between quality improvement and clinical research, and faculty engagement depends on connecting improvement work to academic recognition, department metrics and career advancement.

Residents and fellows rotate constantly. A resident on a three-month rotation may need to report safety events, understand the department's priorities and contribute to a project, then hand it all to the next cohort. Knowledge loss is a structural feature of academic medicine, and improvement systems need to plan for it.

ACGME's Common Program Requirements (2025) say residents, fellows and faculty must actively participate in patient safety systems, know how to report patient safety events and unsafe conditions, and take part as team members in real or simulated interprofessional patient safety and quality improvement activities such as root cause analyses. Residents must also receive data on quality metrics.

ACGME's Clinical Learning Environment Review (CLER) program, which concluded in late 2025 after four cycles of site visits, showed how far there is to go. In its final national report, 72% of residents and fellows said they had experienced an adverse event, near miss or unsafe condition, but only 55.6% of those had personally reported it. About 60% of residents in their third year or later had taken part in an interprofessional investigation of a patient safety event.

1. 1Make safety reporting quick enough that residents report events themselves rather than leaving it to a supervisor or nurse.
2. 2Show residents what happened to their reports and share summary data with each program, as the ACGME requirements expect.
3. 3Give every rotation a way into active improvement projects, with the project's history and measures in one place for the next cohort to pick up.
4. 4Set up reporting that rolls up by department, service line and institute without forcing every area into one workflow.
5. 5Give department chairs and program directors a view of the improvement work their faculty and trainees lead, so it can be recognized.

• Improvement projects with a guided A3 and PDSA cycles, so a rotating team can see the reason for action, the tests run so far and the measures before they add their own work.
• Projects linked to the safety events and metrics that started them, giving a traceable thread from a resident's report to a confirmed result.
• A view of active projects across units and sites for quality leaders, with templates your coaches can customize to the A3 they already teach.
• Safety reporting from any device, so residents and fellows can report from day one of a rotation.