UCSF to Train Residents in Lean Management and Process Improvement

Part of ACGME’s Pursuing Excellence in Clinical Learning Environments Initiative

By Laura Kurtzman

UC San Francisco will train medical residents and fellows in Lean management principles, as part of a broader institutional commitment to continuous quality improvement. The effort is being supported in part with a grant from the Accreditation Council for Graduate Medical Education (ACGME) through its Pursuing Excellence in Clinical Learning Environments initiative. UCSF was one of eight medical training sites nationally to receive the competitive grant.

The Pursuing Excellence initiative emerged from an intensive examination by ACGME that involved nearly 300 visits to find out how to help teaching hospitals and other clinical settings improve patient safety, health care quality, care transitions, supervision, duty hours, fatigue management and professionalism. Resident engagement in patient safety and health care quality was one of four themes that arose from ACGME’s examination. The others, which UCSF will also address, are integrating graduate medical education into the organization’s strategic planning; continuing education for faculty and program directors in health care quality, patient safety and other systems-based initiatives; and using education resources across the different health care professions.

Over four years, UCSF will seek to incorporate changes already underway in the health care delivery system into graduate medical education. Residents will emerge better prepared for the evolving value-based payment environment, and patients will experience care that is more effective, safe, timely, patient-centered and equitable.

“UCSF feels privileged to be part of this four-year commitment to working with the ACGME and seven other select institutions to promote transformative improvements in the clinical learning environment,” said Robert Baron, MD, MS associate dean for graduate and continuing medical education at UCSF. “This work is fully aligned with the strategic priorities at UCSF Health and is in line with changes in the broader health care environment.”

Lean principles have already been used throughout UCSF Health to improve such processes as patient discharge and medication reconciliation, as well as lessen wait times in the emergency department. In one clinic, lean techniques helped cut no-shows in half, while improving patient satisfaction and employee engagement.  

The new effort will enlist residents and fellows to help ensure that patients make safe transitions from one level of care to the next, for example from the emergency department to inpatient units. Using Lean techniques, residents and fellows will define the transition process, identify intermediate outcomes, design improvement experiments, analyze results and propose practical counter measures.

“The UCSF School of Medicine has a longstanding commitment to improving clinical learning, providing high value care, teaching inter-professional education, promoting quality and safety and working towards eliminating disparities in health care and education,” said Talmadge E. King, Jr., MD, dean of the UCSF School of Medicine and vice chancellor for medical affairs. “This important initiative will greatly accelerate our progress towards high value care that is not just effective, safe and timely, but also patient-centered and equitable.”

Initially, the work will focus on improving transitions from the emergency department to inpatient units, then move to the ambulatory setting, operating rooms and intensive care units in both the adult and children’s services. Both physicians and non-physicians, including clinical and other staff members, will be engaged in all aspects of the work.

UCSF Health has 86 ACGME-accredited programs serving 1,200 residents and fellows. In addition to UCSF Health, UCSF residents and fellows train at Zuckerberg San Francisco General Hospital and Trauma Center and San Francisco Veteran Affairs Hospital, as well as more than 60 affiliated sites throughout San Francisco and beyond. UCSF officials say they expect other academic medical centers to adopt the process of resident-led continuous improvement.

UCSF prioritized continuous process improvement in the 2014 strategic plan, leading to the creation of a chief innovations office and chief quality officer, as well as the creation of a centralized Lean and continuous process improvement hub. The new structure integrates learning and development, patient safety, quality and experience, faculty and staff engagement, decision support and the electronic health record.

“Residents and fellows are essential members of our health care delivery teams, and our trainees have been helping to bring about quality and patient safety improvements for the past decade,” said Mark Laret, president and CEO of UCSF Health. “The Pursuing Excellence grant will further our commitment to continuous process improvement by embedding systems-based improvement strategies even deeper into our organization. As a leading academic medical center, UCSF aims to catalyze change in every area aspect of medical care, including health care delivery.”

About UCSF

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland – and other partner and affiliated hospitals and healthcare providers throughout the Bay Area. 


The ACGME is a private, non-profit, professional organization responsible for the accreditation of approximately 9,600 residency and fellowship programs and approximately 700 institutions that sponsor these programs in the United States. Residency and fellowship programs educate over 120,000 resident physicians in 130 specialties and subspecialties. The ACGME’s mission is to improve health care and population health by assessing and advancing the quality of resident physicians’ education through accreditation.