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CLER Site Visit

CLER site visits are divided into two major categories: Sponsoring Institutions that have many residency and/or fellowship programs, and Sponsoring Institutions that have relatively few programs. The second cycle of the larger institutional visits began in the spring of 2015, and the first cycle of the smaller visits was initiated in the fall of 2015.

CLER site visits are short-notice visits. The institution's Designated Institutional Official (DIO) will be contacted no fewer than 10 days before the visit to confirm the DIO and Chief Executive Officer (CEO) will both be available to attend the mandatory opening and closing meetings. If a visit cannot be confirmed within 24 hours of that contact, the institution will be charged a "pass." Institutions may pass three times without penalty. If a Sponsoring Institution fails to complete a CLER site visit, the ACGME administration may recommend to the ACGME Board that it place the Sponsoring Institution on Administrative Probation for no less than 24 and no more than 36 months. Institutions are also given three opportunities during the year to provide five "blackout" dates for the next four months for the CLER team to attempt to avoid in scheduling.

Detailed information regarding site visits will be shared with the institution's DIO before each visit.

Site Selection

In the current cycle of CLER visits, site visitors will visit one participating site per Sponsoring Institution. However, the site visitors may elect to go to more than one location at that site, especially if there are ambulatory clinics or specialty facilities (such as a children's hospital or cancer center) on campus and within walking distance.

Pre-Visit Background Materials

The following information, while not required, will be helpful in providing the site visitors with background on the site's clinical learning environment.

  • Organizational charts: Sponsoring Institution, participating site that is being visited, and quality and safety departments within participating site (if not included in site chart)
  • Sponsoring Institution's supervision policy (and participating site's policy, if different)
  • Sponsoring Institution's duty hour policy (and participating site's policy, if different)
  • Sponsoring Institution's care transitions policy (and participating site's policy, if different)
  • Participating site's patient safety protocol/strategy (approved by its Board)
  • Participating site's quality strategy (approved by its Board)
  • Participating site's quality and safety committee membership roster(s) (identifying resident members, if relevant)
  • DIO's most recent annual report to the Sponsoring Institution's governance (or minutes of the meeting if the report was given orally)

Scheduling the Group Meetings

CLER site visitors cover a lot of ground in a very short amount of time. Experience to-date has shown that meetings are most productive when participation is limited to certain key stakeholders. For each type of meeting listed below, participants and other logistical instructions are outlined as specifically as possible. The lead site visitor will be happy to discuss any additional questions after contact has been made to schedule the visit.

Institutions will be asked to forward the names and titles of the senior leadership and safety and quality improvement leadership meeting attendees to the lead site visitor several days in advance of the site visit. It is also helpful to have a complete list of all meeting participants one day in advance of the visit. The following individuals should be available for various meetings in accordance with the schedule that will be sent to you at the time the CLER site visit is confirmed:

Senior Leadership Meetings (attend both the initial and exit meetings):

  • CEO and DIO (required)
  • Chief Medical Officer (CMO)
  • Chief Nursing Officer (CNO)
  • Chair (if different from the DIO) and resident member of the Graduate Medical Education Committee (GMEC)
  • Chief Operating Officer (COO)
  • Chief Financial Officer (CFO)
  • Dean of affiliated medical school

Note:

  • The CEO and DIO must be present for the duration of both the initial and exit meetings. If either the CEO or the DIO becomes unavailable prior to or during the course of the site visit, the visit will likely be canceled.
  • For those listed above other than the CEO and DIO, attendance is strongly recommended, but not required. If necessary, these individuals may elect to send a designee on their behalf.
  • The CLER program recognizes that some clinical sites are part of larger health systems or consortiums, and that lead positions have varying titles (e.g., CEO, President, Executive Director). Sometimes identification of the "CEO" is more complicated. In such circumstances, please focus on the individual who has responsibility for both the strategic and financial decisions for the participating site. If there are questions regarding which CEO to invite, please discuss the issue with the lead site visitor at the time of scheduling.
    • Please do not invite any other individuals to attend the senior leadership meetings. Attendance is limited to those listed above.


DIO meetings:

The site visit agenda has specific meeting times for the team to visit with the DIO.

Note: Other representatives of graduate medical education leadership (e.g., associate DIOs, GME directors, coordinators) are welcome to attend these meetings at the discretion of the DIO.

Quality and Patient Safety Leadership Meetings:

Chief Quality Officer

Chief Patient Safety Officer

Chief Medical Information Officer

Director, Risk Management (potential attendee—see note below)

Note:

  • Often the Chief Medical Officer (CMO) serves the dual role of Chief Safety or Quality Officer. In these situations, as the CMO is part of the senior leadership meetings, please identify alternate individuals to attend the quality and safety leadership meetings—the CMO should not attend both sets of meetings.
  • In these meetings it is helpful to include the individual who tracks patient safety event reporting for the selected hospital or medical center. In some organizations, this activity is the responsibility of the Chief Patient Safety Officer. In others, it is a function of the Office of Risk Management. If the latter is true, please include someone from Risk Management.
  • Many organizations have multiple Patient Safety Officers or Quality Officers – often assigned at the department level. In these situations, please limit the invitation to the one or two individuals to whom these various officers report.
  • With regard to quality leadership, it is recommended that the most appropriate person to represent the hospital or medical center is the individual who is most closely associated with quality indicators and data reporting—working with physicians on measuring, monitoring, and improving system processes.


Group Meetings:

  • The discussions occurring in the group meetings focus solely on the hospital or medical center being visited. As such, please invite only individuals who spend time and are familiar with the resident/fellow experience at that particular site.
  • The number of meetings will vary by the size of the Sponsoring Institution. In general, if the Sponsoring Institution has 30 or fewer programs, one meeting each of residents/fellows, faculty members, and program directors will take place. If the Sponsoring Institution has more than 30 programs, two separate meetings for each group (with different participants in each meeting) will take place.
  • Each meeting will be capped at 30 attendees.
  • While we realize that not everyone may be able to turn off or surrender pagers for the duration of the meeting, we would appreciate any assistance you may be able to provide to minimize disruptions.


Resident and Fellow Group Meetings:

Please invite residents and fellows who will provide broad representation of the ACGME-accredited programs at the selected participating site.

Note:

  • With the exception of transitional year residents, please limit attendance to those at the PGY-2 level or higher.
  • Attendees should be peer-selected. The ACGME defines "peer-selected" residents/fellows as those voted on by their peers [other residents/fellows] and not chosen by a chief resident or another program representative.
  • We would like to aim for broad representation across all of the Sponsoring Institution's ACGME-accredited programs rotating at the selected participating site. It is also appropriate to include proportionally more individuals from the larger programs.
  • Please select residents and fellows for the group meetings who are not attending other CLER activities, such as the senior leadership meeting and the walking rounds.
  • If two group meetings are requested, please invite different individuals to attend each meeting.


Faculty Member Group Meetings:

Please invite core faculty members who will provide broad representation of the ACGME-accredited residency and fellowship programs at the selected participating site.

Note:

Program directors will be asked to attend a separate meeting and should not attend the faculty member meetings.

  • While we would like broad representation of all the site's accredited programs, it is also appropriate to include proportionally more individuals from the larger programs.
  • If two group meetings are requested, please invite different individuals to attend each meeting.


Program Director Group Meetings:

Please invite the program director of each ACGME-accredited program (residency and fellowship) at the selected participating site.

Note:

  • If the program director is unavailable, he/she may send an associate program director as a designee.
  • In cases where the DIO is also a program director, please have the associate program director or other designee attend the group meeting.
  • If two group meetings are requested, please invite different individuals to attend each meeting.


Walking Rounds:

You will be asked to select one or more chief or senior residents (PGY-3 or higher) to guide each site visitor on walking rounds on the floors.

Note:

  • If possible, please select residents/fellows who have not participated in the group meeting.
  • Please select residents/fellows other than those participating in the senior leadership meetings.

Meeting Room Logistics

The site visit involves the use of an audience response system which is installed on the site visitor's PC laptop. Therefore, the laptop must be able to be plugged into an on-site video projection system in order for it to be used during the site visit.

The ideal situation is to arrange for a single conference room (that can accommodate up to 35 individuals) for all of the meetings. However, with short notice, this is not always possible. If the meetings will be held in several rooms, the site visitors will need access to the room where the resident/fellow, faculty member, and program director group meetings will take place at least 30 minutes before and following the scheduled meeting time in order to set up and break down the audience response system.

Please avoid large auditoriums.

The site visitors do not need a separate room for "team huddles"; ideally they would use the room scheduled for the following meeting if it is available.

The conference room(s) provided for the resident/fellow, faculty member, and program director group meetings should have a screen or blank wall on which PowerPoint slides can be projected. If possible, a projector should be made available; if not, the site visitors will come prepared with their own.

If possible, the room for the group meetings should be configured in a U-shaped or board room set-up, rather than theater style, so as to facilitate discussion.

The site visitors will need help in identifying a secure place to leave their equipment and personal belongings during the walking rounds (e.g., a locked conference room or office, the hospital security desk, or a room with a monitor posted outside).

Visit Logistics

Security badges:

The site visitors all have ACGME picture ID badges. Please let the lead site visitor know at the time of the scheduling call if the hospital or medical center being visited has additional requirements, and arrange to have visitor badges prepared in advance. If additional time is necessary (e.g., for photographs) please let the lead site visitor know in order to facilitate this process.

Meals and snacks:

  • Providing a simple lunch (sandwiches or salads) for the site visitors would be appreciated, but is not required. The site visitors use the scheduled lunch time to "huddle" and debrief among themselves and so will politely decline any invitations for others to join.
  • Please avoid providing lunches for the group meetings as it detracts from valuable discussion time.


Transportation:

If the participating site is located in an area where taxi cabs are not immediately accessible, the site visitors would appreciate advice or assistance in arranging for a taxi or local car service.

Blackout Dates

The CLER Program offers a time-limited feature allowing DIOs three times during the calendar year to submit up to five dates they prefer the CLER site visitors avoid when scheduling visits. These opportunities are:

  • For dates during January, February, March, and April – the window to enter dates is November 2-November 30
  • For dates during May, June, July, and August – the window to enter dates is March 1-March 31
  • For dates during September, October, November, and December – the window to enter dates is July 1-July 29

In 2016, the CLER program will also avoid scheduling site visits on the following dates:

  • New Year's Day (1/1)
  • Martin Luther King, Jr. Day (1/18)
  • President's Day (2/15)
  • Memorial Day (5/30)
  • start of academic year (6/27-7/8)
  • Labor Day (9/5)
  • Thanksgiving (11/24-25)
  • Winter Holiday (12/23-12/30)

To utilize this opportunity, DIOs should log into the Accreditation Data System (ADS), select the "Institution" tab, and then click on "Blackout Dates" in the right navigation panel. When selecting dates, consider any additional holidays observed at the organization, and check with the CEO of the participating site to be visited to identify known dates of unavailability (such as Board meetings). The CLER program will make every effort to comply with requests, however there is no guarantee that a program will not be contacted for a visit during these times.


Contact CLER Staff
Vice President, Clinical Learning Environment Review (CLER)
Robin Wagner, RN, MHSA
312.755.5054
Director, CLER Operations
Betsy Kimball, MA
312.755.7133
Other CLER Resources
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