Hospitalists should consider the hospital their research laboratory,” says Mark V. Williams, MD, FACP, professor of medicine, director, Emory Hospital Medicine Unit, and editor-in-chief of the Journal of Hospital Medicine. “Just as research scientists consider beakers, pipettes, and spectrometers as some of their research tools, we can consider computerized information databases, chart review, and QI projects the tools we use to figure out how we can best deliver care to patients.”
But what are the best ways for hospitalists to conduct research in their institutions? The challenge, says Jeffrey L. Schnipper, MD, MPH, director of clinical research, Brigham and Women’s/Faulkner Hospitalist Service (Boston), and associate physician, Division of General Medicine at Brigham and Women’s Hospital, is that hospitalists are tied to processes—not single interventions.
“The goal of my research,” says Dr. Schnipper, “is to move beyond ‘I got it to work at my hospital’ to ‘this works, in general, at any hospital.’ The vast majority of my projects are related to inpatient quality improvement. Unfortunately, that is not a ‘blue pill.’ If I prove that my quality improvement method improves diabetes control, you still have a lot of work to do to implement it at your hospital.”
How can hospitalists parlay their natural inclinations to improving systems into research that is publishable and generalizable? Healthcare researchers interviewed for this article maintain that savvy use of tools generated from quality improvement research combined with traditional scientific methods can help busy hospitalists streamline their approach to identifying, designing, and conducting valid research projects with publishable results.
Those interviewed for this article agree that the push for quality improvement dovetails with hospitalists’ mission and approach to patient care. “Hospitalists are very systems-oriented,” says Dr. Schnipper. “They are trying to improve not just the care of their individual patients, but the way the whole system works and runs. Frankly, in any environment in which we work, we have a vested interest in making it run better.”
Hospitalists provide a valuable link in the quality improvement chain, agrees Brent James, MD, executive director of the Institute for Healthcare Delivery Research, at Intermountain Healthcare, an integrated delivery system serving 1.2 million patients in Utah, and a leading QI researcher. “Any time you have a group of people who are trying to deliver coordinated care together, and who rely heavily on being able to support each other as a team, this is just an absolute natural model [for conducting QI studies],” he says.
Dr. James was a member of the Institute of Medicine’s National Roundtable on Quality and its subsequent Committee on Quality of Health Care in America that published Crossing the Quality Chasm in 2001. He also just finished a three-year project with the Hastings Center, Garrison, N.Y., funded by an Agency for Healthcare Research and Quality (AHRQ) grant, to examine the ethics of quality improvement.
“Given the quality chasm,” he says, “there is an ethical obligation for physicians, nurses and health professionals to do quality improvement. It surely shouldn’t be a choice—it’s a way of rigorously learning from your own practice.”
Dr. Williams explains that hospitals will increasingly undertake quality improvement initiatives, not just to improve care delivery in their facilities, but in response to pay-for-performance requirements being set up by the federal government and insurers.
“I strongly believe that hospitalists are going to be seen by many hospital administrators as not only collaborators but the leaders of these initiatives,” says Dr. Williams. “And those initiatives can be a form of research if conducted properly. It does require having sufficient resources from the hospital. I don’t think it’s something you can do on Saturday and Sunday nights.”