Hospitalists are ideally positioned to help create new approaches to hospital quality and safety, but they must acquire the skills necessary to make sustained, systematic changes, says David W. Baker, MD, MPH, The Joint Commission's executive vice president of healthcare quality evaluation.
“Hospitalists know the system inside and out, and they have great ideas on how to improve care," Dr. Baker says. In a recent article he coauthored in JAMA, Dr. Baker describes the issue as crucial.
"We as physicians need to do a better job improving quality and safety, otherwise we're going to lose what autonomy we still have," he says. Tolerating quality and safety problems as an inevitable part of giving care will bring about increasing external forces regulating physicians, he adds.
Instead, physicians should embrace the goal of zero harm.
"It's not some overly idealistic, unattainable goal," Dr. Baker says. He points to Memorial Hermann, a health system in Houston. "Hospitals in their system are achieving zero harm on measures such as central line infections month after month."
To make such changes, hospitalists must understand modern principles of QI—including the tools of Lean Six Sigma—principles that The Joint Commission has fully adopted.
"Right now, hospitals do individual projects, but we need to think about systems of care and how we can develop interventions that are sustainable and achieve high reliability," Dr. Baker says. "For many physicians, that requires a different skill set."
Developing these systems means cutting out unnecessary steps and therefore saving money so they can achieve cost neutrality. "The critical thing is understanding the principles of change management so these things really become part of the culture of an organization," he says. "That's what hospitalists really need to learn to be able to do these projects so they’re truly sustainable." TH