The CLER Initiative
In the late 1990s institute of medicine did a study which showed problems with patient safety, variability in quality care, and significant health care disparities. They have found that these problems are still present and have not improved. Physicians are an important part of fixing these problems. The ACGME understands that resident physicians work on the frontline of care. In this role they need to be prepared to recognize patient safety events and intervene when appropriate, champion performance improvement efforts, and work effectively in inter-professional teams on system-based practice issues such as transition of patient care.
To ensure that our future generations of physicians can accomplish what is needed, the ACGME has implemented the CLER initiative. The CLER initiative stands for the Clinical Learning Environment Review. This initiative sets the expectation that teaching institutions need to strive for an optimal clinical learning environment to achieve safe and high-quality patient care.
The CLER program designed is based on 6 focus areas. 1. Patient Safety. 2. Health Care Quality. 3. Teaming. 4. Supervision. 5. Well-being. 6. Professionalism. Each of these focus areas can be broken down into multiple pathways, which act as sub-focuses. A lot of ACGME survey questions are related to these pathways. The ACGME knows that “toxic programs” are a direct threat to patient safety and health care quality, which is why you see Well-being, Supervision, and Professionalism on this list of key focus areas.
It is interesting to know that the six ACGME focus areas (listed in part 1) have changed over time. In 2014 they were 1. Patient Safety. 2. Health Care Quality. 3. Care transitions. 4. Supervision. 5. Duty Hours/Fatigue Management & Mitigation 6. Professionalism. In 2017 the Duty Hours/Fatigue Management was changed to Well-being. In 2019, the transitions of care focus, was replaced by a focus on “Teaming”. The ACGME decided to use “Teaming” to place greater emphasis on the clinical care team (and resident and fellow physicians as members of the team). As per the ACGME, “The concept of teaming recognizes the dynamic and fluid nature of the many individuals of the clinical care team that come together in the course of providing patient care to achieve a common vision and goals. It also recognizes the benefits of purposeful interactions that allow team members to quickly identify and capitalize on their various professional strengths –coordinating care that is both safe and efficient.” Dr. Winston has a lot of insight into how the hospital is using teaming to try and improve patient care.
