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Hospitalists Have Stake in Improving Quality, Patient Safety


Maureen Bisognano, president and CEO of the Institute of Healthcare Improvement, talks about “Leading Transformational Change” at HM15.

Maureen Bisognano, president and CEO of the Institute of Healthcare Improvement, talks about “Leading Transformational Change” at HM15.

NATIONAL HARBOR, Md.—Don Lee, MD, MPH, is building what one might call an analog quality improvement (QI) project focused on reducing readmissions. What the medical director for clinical integration at Columbia St. Mary’s in Milwaukee does is work with patient navigators to make follow-up phone calls after discharge to get ahead of potential issues.

What he wants to do is design a system that ensures that happens.

So, he came to HM15 for help.

“I’m very interested in continuous quality improvement. I wanted to work on how to not only get the project off the ground, but also to make sure what we are doing is good, and it’s doing what it’s supposed to be doing,” Dr. Lee says.

Well, he came to the right place. Quality and patient safety are hallmarks of the annual meeting; this year’s gathering was no exception. Plenaries provided advice from national thought leaders on improving safety by improving the patient experience; breakout sessions focused on how to build, maintain, and sustain QI projects; and SHM unveiled a new educational track dubbed the “Doctor-Patient Relationship.”

Hospital medicine, and healthcare in a broader sense, needs to be able to define safety better to attack it proactively, says Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI). She compared medicine to NASA, which tracks its missions in a continuum of both successes and failures to understand what processes and protocols lay behind each.

Medicine has no such pathway laid out to date, though Bisognano said her task for the next year is to try to define one.

“We don’t know what the system of safety looks like,” she said. “We don’t know how many times we duplicate tests on admission because we haven’t connected with primary care. We don’t know how many times we send somebody home with inadequate social support, no food, and no way to pick up their prescription.

“We don’t have a sense of where our near-misses are, so we don’t have a vision of safety.”

Hospitalist Kedar Mate, MD, senior vice president for innovation at IHI, says that QI projects can seem daunting in the midst of daily censuses, hospital committee meetings, and a myriad of other responsibilities physicians face. But much of that fear is perception. A project can be simple or system-wide. The trick is just getting started in the face of perceived hurdles, he adds.

“Language around quality improvement tends to confuse and create mystery, and the jargon and so on creates interference,” says Dr. Mate, an assistant professor of medicine at Weill Cornell Medical College in New York City and a research fellow at Harvard Medical School’s Division of Global Health Equity. “It’s not that mysterious. It’s kind of a straightforward thing, actually, if you work through it logically and stepwise.”

And, as front-line providers, hospitalists are primed to lead healthcare systems in how to deliver care, he said.

“Formerly, physicians were iterant, right?” Dr. Mate adds. “They would come in and out of institutions and didn’t really have a stake in the game, on some level, of institutional quality. That’s totally different now.”

But, while the individual hospitalist has a responsibility to embrace safety initiatives, employers and industry groups have a duty to provide the proper resources to make that connection easier.

“The individual’s responsibility is to try to access that information to carry on in the face of busy schedules and busy lives,” Dr. Mate says. “SHM, IHI, and others have a responsibility to try to make those that are inclined able to continue and able to build and move their efforts forward in an even more productive way.”

Inclined docs like Dr. Lee, who know that their hospitals collect reams of data that can be useful for patient safety projects, many times have no idea how to extract said data. He has learned that partnering with “gatekeepers” is a way to help others help him.

“We are collecting data every second, every minute,” Dr. Lee says. “It’s amazing how much data we have, but to actually sift through it and make it meaningful is very difficult. You have to know what questions to ask and you have to get buy-in from the [gatekeepers], because they get thousands of requests for data extraction.”

Richard Quinn is a freelance writer in New Jersey.

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