Engaging residents and fellows to improve institution-wide quality: the first six years of a novel financial incentive program

Acad Med. 2014 Mar;89(3):460-8. doi: 10.1097/ACM.0000000000000159.


Purpose: Teaching hospitals strive to engage physicians in quality improvement (QI), and graduate medical education (GME) programs must promote trainee competence in systems-based practice (SBP). The authors developed a QI incentive program that engages residents and fellows, providing them with financial incentives to improve quality while simultaneously gaining SBP experience. In this study, they describe and evaluate success in meeting goals set during the program's first six years.

Method: During fiscal years (FYs) 2007-2012, QI project goals for all or specific training programs were set collaboratively with residents and fellows at the University of California, San Francisco (UCSF). Data were collected from administrative databases, via chart abstraction, or through independently designed techniques.

Results: Approximately 5,275 residents and fellows were eligible and participated in the program. A total of 55 projects were completed. Among the 18 all-program projects, goals were achieved for 11 (61%) in three domains: patient satisfaction, quality/safety, and operation/utilization. Among the 37 program-specific projects, goals were achieved for 28 (76%) in four categories: patient-level interventions, enhanced communication, workflow improvements, and effective documentation. Residents and fellows earned an average of $800 in bonuses/FY for achieving these goals.

Conclusions: Thousands of residents and fellows across disciplines participated in real-life, real-time QI during the program's first six years. Participation provided an experience that may promote SBP competence and resulted in improved quality of care across the UCSF Medical Center. Similar programs may assist teaching hospitals and GME programs in meeting current and future QI and training mandates.

MeSH terms

  • Education, Medical, Graduate / economics
  • Education, Medical, Graduate / methods*
  • Hospitals, University
  • Humans
  • Internship and Residency / economics
  • Internship and Residency / methods*
  • Motivation
  • Patient Safety
  • Patient Satisfaction
  • Program Development*
  • Quality Assurance, Health Care / methods*
  • Quality Improvement*
  • Reimbursement, Incentive*
  • San Francisco