The EPIC Project:
Emergency Physician In-house challenge
- Stressful working environment
- Often heavy workload
- Perception of 'digging a hole in sand'
- Lack of engagement with educational activities especially WPBAs (work place based activities)
- Poor recruitment and retention of staff especially in UK
- Juniors have to work in ED even if they don't want to, as part of rotations
Interesting talk about rewarding the brain and what makes people so addicted to gaming on TED.com by Tom Chatsworth (http://www.ted.com/talks/tom_chatfield_7_ways_games_reward_the_brain)
I started to think that maybe we could introduce some of those motivating, fun principles to our work in the ED and thus EPIC was born. To my knowledge (and a literature search) there is nothing like this out there currently.
We managed to get funding from Better Training Better Care, a part of Health Education for England for a 1 year pilot project in The Royal Oldham Hospital, Lancashire, UK which ran from August 2012 to August 2013.
It has proved very popular and successful and has now rolled out to all the other ED's in Pennine Acute NHS Trust and we are looking at introducing it in Orange, NSW. It is currently being written up for submission for publication.
- Competition with peers and see where you sit on a live 'Dashboard'
- Early detection of outliers, with reward for 'high fliers', and early support for those struggling
- Improved educational activities (medical student teaching, WPBA's, courses etc)
- Encourage positive (audit, service improvement, procedures) and discourage negative (coming late, patient complaints) activities through giving or fining credits (respectively)
- Recognition from peers and others as you move from 1 level to the next level (Levels 1-6) with medals and certificates (in the pilot small actual prizes e.g. gift vouchers, iPod shuffles etc were given)
- Use of gathered data to guide training needs with trainers
- See Project Details
- See Rule Book and detailed Process
- Credits earned by seeing patients (weighted for triage category) and linked automatically to Dashboard
- Credit slips filled completed and entered into Access database & linked to Dashboard for medical procedures (weighted), Work Place Based Assessments (WPBAs), taking medical students for the day, Audits, life support courses etc. Some grade specific (e.g sedation for Registrars)
- Bonuses for early WPBAs completed, seeing patient between 7-8am (traditionally a lag period)
- Rarely fines for complaints, repeatedly arriving or leaving late
- As certain credit score levels reached, person moves from Level 1 up to 6 with small prizes at each level
- Overall highest score for the year award
- Top 2 high scorers on Dashboard have names on (rest anonymous) to give encouragement
- EPIC steering group with representatives form all trainee groups to guide changes, rules etc
- it was FUN! & well received by trainees (and trainers)
- Productivity improvement of 20% in JMO (FY2, GPVTS, ACCS etc) grade
- Massive improvement in educational activities, especially WPBA's (25% in foundation docs and 2-3 fold increase in GP VTS and ACCS groups)
- No increase in adverse incidents or complaints over the period despite increased workload
See full report HERE