 Now, we're going to move ahead with our presentations. We're going to go from the one fellow who is speaking through residence third year to first year. Our first speaker, Zach Joss, finished as a resident here a year ago. He has been doing additional work related to the residency program. And he's getting ready to leave for an Oculoplastic Fellowship in Australia in a month. He is going to talk to us today about some quality improvement issues in the residency program. Did I get that right? That's right. Oh, good. Thank you. Morning, everyone. Sorry, it's a little early for this topic, but it's like getting a Band-Aid off. We'll just get it done really quick here. So basically, I'm just going to talk quickly about the university's kind of undergone this transformation over the last several years about incorporating quality improvement projects into the university setting. And they've really done a great job. And the Moran Residencies, we've developed some programs to try to keep up with this and make sure the residents are involved in it. Basically, I'm going to start off. What is quality improvement? So this is Jeff Petty, our program director. And this is how he meets with the residents every morning up on the balcony, so he can pontificate about whatever. So basically, he asked the residents back at the beginning of the academic year, what is quality improvement? So we are going to move up the resident ladder. We'll start with the first-year resident. So Dr. Riesweis, we asked at the beginning of the year, what is quality improvement to mean to you? And he gave a pretty standard answer for a reason. He said, nobody knows, roll tide. He's from Alabama, so that makes sense. So and actually, he's given me this answer several times. It's here to other clinical questions, so it's not just quality improvement. So next, we moved up to the PGY2 ladder. Dr. Renee Choi, MD, PhD, asked Renee early in the year, what is quality improvement mean to you in the ophthalmology setting? And he kind of tried to confuse me with his intellect. And basically, he did a good job. And he basically, he pulled out a napkin and started drawing the entire VEGF pathway of the revenue. And albeit accurate, it was not the answer I was looking for. Then I moved up to our chief resident, Brian Stagg. Brian, what does QI mean to you? And in typical fashion, he said, super interesting questions, Zach. And he pushes up his glasses. And I've actually found over the year that this is the way his way of delaying an answer so he can think of a correct answer. And then he went on to say, QI is another project I can add to my already prolific CV. If you've seen his CV, it's crazy. And then he said, I'm thinking of doing a fellowship in QI, so in addition to his three other fellowships. So but those are not the answers we're looking for. So throughout the year, we've taught them what QI means in ophthalmology. So what is it really? QI is a formal approach to the analysis of performance and systematic efforts to improve it. What does that really mean? That's kind of a lot of words too. Basically, there's a lot of processes taken from the industry. Anybody that's working in the industry may have heard these programs called Six Sigma Lean PDSA, which is an acronym for Plan Due Study Acts. It's just the process in which people identify problems and improve upon them and re-evaluate them. CQI stands for Continuous Quality Improvement and then FADE is another acronym. Basically the same process. But each model basically reflects a common thread of identifying and analyzing a problem, implementing the problem, planning how to improve the problem, and then continuous review of the problem. So that's really the key point. It's a cyclical process. So once you come up with the process, you have to continually try to improve it. These are all designed to maximize value. Value is kind of a vague term. How do we define value? That's difficult. And then to eliminate waste. So why do hospitals care about QI? Some of the reasons that aren't necessarily proven. Does improving quality improve patient care, possibly in some settings? Does it reduce costs of health care, possibly in some settings? And also, there's potential for higher reimbursement with quality improvement. So what has the University of Utah done? They've actually designed this value university, which is a online training program for physicians and other health care professionals in which it ranges from online videos and lectures where you can just teach yourself at home how to start quality improvement projects, and all the way through semester-long courses at the university to really make people experts in the quality improvement process and leaders in that field. One of the other things that you can access of the university system is this value summary portal. All of our residence projects can be found in the Value Summary Library. Moran has ongoing probably about 15 projects that are seen on this. And throughout the university, why several hundred projects going on that you can actively look up and see what people are doing across all the other departments at the university. So what has the Moran Residency done to keep up with QI? We designed a QI curriculum this year with the help of Dr. Petty, Dr. Warner, and the academic team, and actually input from the residents and people up at the university where we've given them lectures and training them how to do a project. We've had journal clubs about it and giving them online training resources that I showed. And then each resident has either individually or collaboratively done a project together. Each of the residents will just show about one slide after their main talks today, just talking about what they've been doing for QI this year. And my last thing I want to leave you with is this was an article in Washington Post just a couple of weeks ago, written by Harvard Medical School Department and the Psychiatry Chairman. And I think it's just, I'm going to read the quote, so endless meetings and initiatives to make processes leaner and to remove waste may be imperative for the responsible viable running of the teaching hospitals, but the relentless focus on these real concerns increasingly comes up against the point beyond which staffing and funding cuts endanger the academic mission. Before endangering patient safety, the point no one wants to reach. So I think even though that's great, we have all these quality improvement projects and making processes leaner, I think that we also need to keep in mind overall that this is an academic institution just because we can maybe make a cut or make something more efficient, it's not necessarily totally in line with the academic mission of the hospital. This is kind of the end point of a lot of patients' care. So there's a tertiary referral center. We need to keep in mind that because this is the end of the road, it may not be the most efficient place. We can try, but we need to keep in mind that this is a teaching hospital and just because we can make something leaner necessarily, it may not be the best thing for patient care. So I'll leave you with that. Thank you to all the residents for their participation in putting up with me this year, pounding you about your QI projects. Dr. Warner for letting me kind of take this project on and she's been a lot of help. And then Luca Boyd, he's not here, he's actually in the Value Engineering Department, the department I never knew existed, but he's been a lot of help. So any further readings can be found on the University website and thank you all for your time today. Thank you.