As I follow Mary Jo Gorman, MD, MBA, as president of SHM, it might be tempting for me to simply follow the leading rule of the “organizational” Hippocratic Oath and “First do no harm.”
Put another way, in the context of the success SHM has enjoyed for the past 10 years, there is a case to be made for standing out of the way of our society’s positive momentum. But I believe we can—and will—do better than that. None of us can afford to be spectators in this arena.
We often speak of teamwork in healthcare, but precious few of us intuitively know what this means—much less have any education in its principles. During my training, the idea of teamwork amounted to little more than relying on a medical assistant to obtain daily weights or counting on the pharmacist to calculate and follow the appropriate dosing schedule for gentamicin. Common sense led me to understand that building an amicable relationship with the nursing staff made my working life easier.
Slowly, the advantages of structuring a more organized team in the hospital setting became more evident and helped encourage me to find ways of exploiting this concept further. As I look back, it was Jeff Dichter, MD, past president of SHM and director of the hospitalist program at Ball Memorial Hospital in Muncie, Ind., who emerged as one of the true champions for teamwork as an optimal model for inpatient care. Jeff would talk about it to everyone who would listen, in every venue he could reach. He wrote about it in this very column. He charged our meeting planners and committee chairs with integrating teamwork principles into our educational content as well as our advocacy and membership development initiatives. His vision of a true team galvanized SHM’s commitment to supporting a broad constituency, extending well beyond hospitalist physicians. Jeff knew care is never delivered by an individual; it’s always a team. And he believed this framework to be fully realized by way of building from a strong organizational agenda for quality improvement.
Speaking of quality in healthcare, I look no further than Mark Williams, MD, editor of the Journal of Hospital Medicine, for having built that agenda for our society through his own efforts as well as collaboration with the Institute for Healthcare Improvement (IHI) and other national entities. As another past president of SHM, Mark brought a level of organizational focus and rigor around quality improvement and patient safety that rose to the challenges outlined in two Institute of Medicine reports, “To Err is Human” and “Crossing the Quality Chasm.” He helped move “quality” from something we talk about to something we do. He pushed it from an espoused value to a core commitment of our specialty. Quality improvement is now inseparable from what I consider to be the true promise of hospital medicine: that care organized in well-orchestrated, well-resourced teams can deliver our patients remarkable improvements in the quality, safety, and experience of healthcare.
But how do we get this done? How do we take a relatively abstract notion of a team, channel its activities to drive measurable improvements in quality, and change the arcane systems of inpatient care so as to sustain and hardwire those improvements?
Leadership. Like it or not, each of you is regarded as one of—if not the—most important leaders in the hospital. Nursing, case management, physical therapy, patients, and families look to you to provide leadership for clinical and operational systems. You are the person most able to make meaningful decisions at the front-line level that directly affect the patient experience. You are called upon to lead and manage change in a volatile environment, to resolve the inevitable conflicts that change provokes, and to reconcile hospital business drivers with quality and safety imperatives.