Teaching quality improvement in occupational medicine: Improving the efficiency of medical evaluation for commercial drivers

Objective: To describe a successful, resident-led quality improvement (QI) project that improved the efficiency of the Department of Transportation (DOT) medical examination process. Methods: After learning QI principles through didactics, workshops, and online modules, residents led a QI project to streamline the process of the DOT examination. An interdisciplinary group of key stakeholders collaborated to analyze the process and to design and implement interventions. Results: Following the Model for Improvement and Lean concepts, residents ran seven Plan-Do-Study-Act cycles over a 4-month period with multiple iteration and testing changes. Compared with the baseline, the team successfully reduced the total visit time (from check-in to check-out) by 28 minutes (102 minutes vs. 130 minutes; P < 0.001). The accuracy of certificate issuance, as proxy for quality of the examinations, improved after the interventions. Conclusions: Residents successfully improved the efficiency of the DOT examination process.