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Healthcare Improvement Guru Maureen Bisognano Sees Hospitalists As Agents for Change


Scan HM15’s meeting schedule, and you’ll see that two of the three keynote speakers are names most every hospitalist knows.

Peter Pronovost, MD. He’s also known as the “checklist doctor.”

Robert Wachter, MD, MHM, is as much a meeting tradition as pre-courses and networking. But in the age of generational healthcare reform that focuses on systems and processes, the plenary session between those two titans of talk shouldn’t get lost. That’s when Maureen Bisognano, president and CEO of the Institute for Healthcare Improvement (IHI), will give her presentation, “Leading Transformational Change.”

“These talks certainly are given at a 30,000-foot level and may not be directly applicable to what I’m going to do this afternoon when I’m taking care of a patient, but it sure is nice to hear what great thinkers have to say about some of these concerns, because in the big picture it really does impact clinical care in the country,” says assistant course director Melissa Mattison, MD, FACP, SFHM, of Beth Israel Deaconess Medical Center in Boston. “These are the leading thought leaders in our society, and understanding what their perspective is and what they think is happening and where we should be turning our attention is always interesting.”

HM15’s keynote addresses kick off with Dr. Pronovost’s presentation, “Taking Quality to the Next Level.” The meeting will end, as it always does, with Dr. Wachter’s address, “The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age.”

What I see in many places that don’t have/use hospitalists is individual clinicians coming in to take care of their body part or their symptom, and the patient ends up needing to be the coordinator at a time when they’re most vulnerable.

—Dr. Bisognano

In between will be the perspective of Bisognano, considered an authority on improving healthcare systems. She is an instructor of medicine at Harvard Medical School in Boston and former CEO of the now-shuttered Massachusetts Respiratory Hospital in Braintree.

She “is a very dynamic speaker, and how [much] greater a partner would SHM have than the Institute for Healthcare Improvement, given that innovation and quality improvement is the core competency of SHM,” says HM15 course director Efren Manjarrez, MD, SFHM. “To have her speak at our annual meeting is just huge.”

Bisognano is just as pleased, because she has worked with hospitalists in the past.

“It’s a critical role that they play, because they are there every single day, and they do take responsibility for those handovers,” Bisognano says. “When hospitalist medicine is at its best, we see them being...the captain of the ship and really orchestrating the care and designing it. What I see in many places that don’t have/use hospitalists is individual clinicians coming in to take care of their body part or their symptom, and the patient ends up needing to be the coordinator at a time when they’re most vulnerable.”

Bisognano travels the country frequently and has a list of four questions she always asks when she visits a hospital. First: Do you know how good you are? That gets at whether the institution has data—and whether they review said data to gauge performance.

Next: Do you know where you stand relative to the best?

“Most leaders look internally at the data, but they have no way of knowing where they stand relative to other organizations,” she says. “When they do see that gap, it’s often very provocative for them.”

Her third question is, “Do you know where your variation exists?” The idea is that even if a hospital is measuring and reviewing data—both internally and as a benchmark against comparable institutions—what good is the data if it doesn’t identify weakness?

“The last question is, “Do you know your rate of improvement over time?” And again, most people think that they’re getting better much more quickly than they actually are,” Bisognano says. “Walking them through these four questions is often a provocative assessment for them, and it does help them speed up the velocity of improvement in their organization.”

It’s a checklist that attendees may take back to their institutions, or it may just revitalize them to view things in a different way. Either way works for Bisognano, as she sees hospitalists playing a key role in healthcare reform. In particular, she’s impressed with hospitalists leading multi-disciplinary rounds where they can develop strong relationships with nursing, therapists, and others in the care continuum.

“When clinicians are running, specialists are running in and out and they’re looking at a specific piece of data. What I find is if they don’t get an answer immediately, they often order another test,” Bisognano says. “That kind of perpetual ordering of tests delays discharge, and it oftentimes doesn’t get to a diagnosis. But I think the hospitalist takes this more total view of the patient and often has the time to sit and make a decision that doesn’t involve testing repeatedly, but gets to a diagnosis more quickly.”

Richard Quinn is a freelance writer in New Jersey.

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