Somebody oughta fix that. I’m sure you’ve heard that phrase from friends or relatives lamenting their recent visit to a hospital.
My grandmother will use just about any opportunity to inform me that hospitals make people sicker. I’ve tried to explain that her perspective is skewed. After all, a lot of her friends were pretty sick before they entered the hospital. But “it’s that place” she vows. “They oughta change it.” Fortunately for me, my grandmother still hasn’t figured out what I do professionally, so I’m not considered part of “they.” I let her rant to my husband, since he has the letters MD after his name.
The truth, as you know, is many hospital medicine physicians and their teams are working their tails off trying to improve inpatient care. Much like my grandmother, hospital administrators haven’t identified who the “they” (change agents) are or what exactly the “it” (practices and systems that lead to suboptimal care) is that needs to be changed. It often is unclear how quality improvement initiatives affect the bottom line or which initiatives will ultimately improve outcomes. Today, a considerable amount of improvement efforts depend on the good will and perseverance of a few champions working with minimal institutional support.
The Hospital Quality and Patient Safety Committee (HQPSC) and SHM leadership recently convened a summit to define a vision for the optimal hospital stay and determine how to best train and support hospitalists as leaders and change agents.
The HQPSC and summit participants concluded SHM is, and should be, a national leader in quality improvement efforts including aspects of education, clinical care, and political advocacy for the hospital setting. To that end, the following strategy recently was submitted by the HQPSC and approved by the SHM Board of Directors to promote development of local, regional, and national infrastructures that support quality and patient safety:
Advance a national quality agenda for hospitals and hospitalists.
- Create a task force reporting to the HQPSC that partners with stakeholders to define the “ideal hospital stay” and promote quality improvement;
- Inform federal accrediting and policy-making groups about the effect of current quality measures and changes required to better support the “ideal hospital stay”;
- Advocate for the alignment of reimbursement practices that reward providers and institutions that demonstrate value and translate these practices into improved quality and patient safety;
- Establish an Acute Care Collaborative (ACC) comprising national organizations representing nurses, pharmacists, case managers, social workers, and other allied medical professionals. The ACC might be expanded to include other key physician groups (e.g., emergency physicians, geriatricians, intensivists); and
- Determine what other key national organizations are doing in quality improvement (QI) and look for opportunities for SHM to partner in these efforts.
Develop educational programs and technical support tools for all practicing hospitalists (entry level to QI leaders) engaged in quality improvement efforts.
- Delineate entry-level and advanced quality improvement offerings. Develop offerings specifically for advanced level participants;
- Expand mentored implementation programs to accommodate more participants and assess the need for other types of programs that provide longitudinal support or coaching;
- Expand current offerings, including resource rooms, mentored implementation, and expert training sessions, to other disease states, system processes, and special populations with attention to coordinating this with SHM’s The Core Competencies in Hospital Medicine: A Framework for Curriculum Development
- Assess the need for new instructional modalities to reach a broader audience (e.g., Web based self-study modules); and
- Promote QI training in medical school, residency, and fellowship programs. Promote systems-based practice and QI throughout the continuum of education. This would include programs that engage medical students, residents, and fellows as well as the development of performance improvement modules (PIMs) for the American Board of Internal Medicine.