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.
Improves the perceived value of implementing and sustaining QI efforts, and hospitalist leadership of those efforts.
- Advocate directly to the C-suites of hospitals to facilitate alignment of incentives that support hospitalists leading quality initiatives;
- Conduct a survey to quantify resources needed for hospitalists to successfully lead quality initiatives and develop safety programs. Develop a white paper based on survey results and distribute it to the C-suite;
- Encourage QI research that creates evidence and outcomes that can influence C-suites to commit adequate resources to QI activities;
- Explore opportunities to use existing local and national infrastructures to promote a more proactive and evidence-based approach to quality and safety rather than reactive and compliance-oriented quality projects; and
- Create a monthly column in The Hospitalist spotlighting QI efforts and assign staff to recruit submissions of “improvement stories” for the Web site.
Evaluate effectiveness of SHM’s current QI resources, educational offerings. SHM needs to assess its current offerings to understand and improve their effectiveness. Process and impact data are needed to obtain external money to create or sustain QI offerings.
- Create robust evaluations and collect better data to assess use and impact of resource rooms, quality precourses, and other SHM offerings.
Promote and support hospitalists as quality improvement experts. Contribute to the “new science” of quality improvement.
- Partner with the Research Committee to define and publish key areas in need of future research related to quality improvement. Advocate to granting agencies to put out RFPs that will help define the ideal hospital stay and support SHM’s research agenda;
- Partner with federal agencies to assess the value of current performance measures and facilitate development of more reliable and meaningful measures;
- Develop trainings for hospitalists on the methods and science of quality improvement research;
- Partner with the Research Committee to develop a research network; and
- Seek money to support demonstration projects that support our quality agenda.
Another goal, to promote development and adoption of health information technology and decision support tools that advance quality and patient safety, recently was discussed by the HQPSC and will be integrated into the next stage of planning.
SHM has an impressive history of working with its members to develop and implement quality initiatives. Our programs have helped reduce rates of venous thromboembolisms, improve glycemic control, and improve the discharge process. Our highly praised online resource rooms provide free tutorials in QI and implementation guides for specific interventions.
More than 250 healthcare professionals have completed our QI pre-course and more than one thousand hospitalists have completed our leadership programs. This momentum, combined with the acceleration of national interest in quality and patient safety, brings an unprecedented opportunity for SHM to advance hospital medicine, promote the highest quality care for our patients, and position hospitalists to be leaders in transforming hospital care.
During the next year, HQPSC will be translating this strategy into specific activities. SHM staff, HQPSC, and other members are developing additional training programs and technical tools.
If you are interested in becoming more involved in SHM’s quality initiatives, please contact me at firstname.lastname@example.org.
If you have a QI success story to share, please consider submission to the Improvement Stories section of the online Resource Rooms or The Hospitalist.
I thank all of you who are part of the “they” who are working tirelessly with SHM to fix “it.” Together we can move mountains, or something more impervious like healthcare systems and performance measures.