The program leaders envision basing the new internal medicine residency curriculum on the SHM Core Competencies in Hospital Medicine and meeting RRC requirements for 33% of the training being outpatient in focus by training the future hospitalists in working to help the emergency department physicians with decision making, opening an outpatient clinic for the first one to two post-discharge follow-up visits, and starting an IMPACT clinic (such as the one started by hospitalists at the Cleveland Clinic) to evaluate preoperative patients.
This new residency program would also promote training in systems approaches, epidemiology, quality improvement, information technology, team building, leadership, and management.
The hope is that by narrowing the focus, this residency can attract better applicants, focus the training on a specific type of future internist, and have their graduates viewed by hospitalist employers as very desirable candidates for future hospitalist jobs.
Obviously, this revolutionary approach is a delicate path to walk. Because this is an idea working its way through its home institution, I have agreed to be purposely vague about where this is being investigated for now. Like the executive leadership at Rockford Health System, if the leadership of this hospital and medical staff can be equally visionary, I expect they will be looking for SHM and everyone else to promote this unique internal medicine residency and get the word out.
Mentored Implementation for QI
Not to be left out, SHM is doing its part in creating innovations to move forward hospital medicine’s agenda of change.
SHM has recently obtained two years’ worth of support from The Sanofi-Aventis Group to create and implement a mentored process to develop the hospitalist leaders who will be trained to measure and improve the quality of care that their hospitals deliver—especially in DVT prevention and treatment. Once these skills are learned, we hope that the same precepts can be used for other disease states that hospitalists manage.
This approach is modeled on similar approaches that have been successful in extending the reach of palliative care training. SHM’s idea is to select 10 outstanding hospitalist leaders and train them to do two fundamental things:
- Use SHM QI tools to measure and improve quality at their institutions; and
- Be trained to mentor future hospitalist leaders.
SHM would then use these initial 10 mentors to train another 30 hospitalist leaders (three for each initial mentor) in QI and potentially as future mentors.
Using this initial two-year project as a learning guide for process improvement and to develop the first cadre of quality mentors, the next step might be to ask for support from a foundation such as Hartford Foundation or Robert Wood Johnson Foundation—or a governmental agency such as the Agency for Healthcare Quality and Research—for broader funding to expand this initiative to 100 or even 500 sites. The goal would be to create a framework that would develop a hospitalist leader trained to lead the quality initiatives at every hospital in the country.
There are other partnerships that SHM is exploring to make this a reality. Recently SHM senior staff and leadership traveled to Boston to meet with senior leadership at the Institute for Healthcare Improvement (IHI). During those meetings, IHI CEO Don Berwick called hospitalists the “army for quality improvement implementation in our nation’s hospitals.” Ambitious undertakings like SHM’s mentored implementation project will be needed to export the well-known and well-documented knowledge of quality improvement and translate this down to the bedside.
Hospital medicine today is much more potential than reality. The history of American innovation is littered with ideas that failed because of issues with scope, scalability, or poor timing. In an era calling for evidence-based medicine, accountability, measured quality, teamwork, and a renewed emphasis on the patient, there are many stakeholders in healthcare rooting for (and even counting on) hospital medicine to turn promise into performance. We must not let the perfect be the enemy of the good. The status quo is just not good enough, and we will need to be risk takers and adventuresome to achieve great things.