At Mercy Hospital in Iowa City, Iowa, the implementation of safety and quality systems is “stirring up the pot,” says Mercy hospitalist and medical director Martin Izakovic, MD.
He has been recruited to supervise Mercy’s latest safety initiatives, including electronic medical records, pay-for-performance measures, development of treatment protocols, standardization of care, and deep-vein thrombosis prophylaxis.
Hospitalists at Mercy face the challenges their peers around the country face in their quest to improve quality and safeguard patients. The leader in these areas needs to be a role model and respected peer for the physicians he or she must lead day after day, says Dr. Izakovic.
How do hospitalists, who are so well-positioned to become leaders in patient safety, develop in that direction?
“The biggest challenge I see is the spectrum of polarization between clinicians and administrators,” he says. “One of the most important qualities that a patient safety officer needs is the ability to overbridge the doctors on one hand and the administrators on the other.”
What They Need
A patient safety officer (PSO) requires a critical mix of clinical and administrative skills, says Peter B. Angood, MD, vice president and chief patient safety officer for The Joint Commission, in Oakbrook, Ill.
On the clinical side, the hospitalist who wishes to be a PSO needs more than awareness of safety and quality improvement processes. He or she must be knowledgeable about and conversant in safety science in industries beyond healthcare. That expertise needs to encompass leadership, behaviors and cultures, human factors, and process redesign or systems engineering. Important, too, is training in how to corral the pieces of an organization and ensure they operate well together.
An understanding of organizational behavior is of great value. The potential PSO should understand how the key players interact: the board of directors with chief executives, chief executives with senior management, senior management with all staff (including the allied professionals), and medical staff with the organization as a whole.
“Because safety is a systemwide process, the patient safety [person] is pivotal in forming a hub from which much of the quality, safety, and process improvement occurs,” says Dr. Angood.
Jason Adelman, MD, MS, former hospitalist and current PSO at Montefiore Medical Center in New York City, says developing patient safety leaders should embrace technology. “Pay attention to the latest and greatest ideas, products, and services,” he urges. “Come up with strategic plans to implement in healthcare, get the information quickly into the hands of physicians, have physicians report, and include forcing functions [whereby computers will not process to completion when key data are missing].”
Above all, the patient safety officer must train to be a change agent. “Influencing patient safety means you have to be there in the capital-allocation process,” says David Shulkin, MD, chief executive officer at Beth Israel Medical Center in New York City. “You have to be there when they’re designing facilities. You have to understand your human resource policies and the skill sets and aptitudes of the people that the hospital is hiring. To be a good patient safety officer, the training needs to involve broad exposure with a slant toward operations.”
Build a Bridge
As a young physician who wanted to develop as a leader in the field of quality and safety, Dr. Shulkin had to forge his own path. In 1992, after he became chief medical officer (CMO) at the Hospital of the University of Pennsylvania in Philadelphia, he fielded several inquiries a month from young physicians who wanted to pursue a similar career. In response to that need, he designed a quality improvement/patient safety fellowship at his school.