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HM10 PREVIEW: Crystal Ball


He’s not a hospitalist. He’s not even a doctor. In fact, less than a decade ago, he was executive director of a Massachusetts water resources board and best known for his views on how to best clean up Boston Bay. But from his perch as president and CEO of Beth Israel Deaconess Medical Center in Boston, Paul Levy is a leading voice in contemporary healthcare, quality measures, and transparency.

HM10’s keynote speaker is most well-known in both medical and management circles for launching a blog in 2006 about the daily operations of his institution, aptly found at Levy, whose address is at 9 a.m. Friday, April 9, spoke to The Hospitalist about his views on the role HM practitioners can play in quality improvement (QI), the importance of communication in medicine, and what he hopes hospitalists can learn from the experiences of his hospital.

Question: What made you accept the offer to be the keynote speaker at HM10?

Answer: I have tremendous respect for the hospital medicine industry. They are positioned to be an exceptionally important part of the care delivery system. In terms of working alongside them, they’re also interesting people. I enjoy working with them.

Q: Why are you looking forward to speaking?

A: I’d like to share our experience with qualitative care improvements and process improvements. The hospitalists, because of their position within the hospital and their relationships (with specialists and with administrators in the C-suite), are on the vanguard of being able to truly improve how we deliver care.

Q: Your address is titled “The Hospitalist’s Role in the Hospital of the Future.” Can you provide an overview of the topics you plan to talk about?

A: It's a classic discussion on how you do process improvement. How do you standardize care? Once you standardize care ... how do you measure that? Hospitalists are in an excellent position to do that because they work on all of the different floors of their hospitals. They are in a position to make meaningful impacts on multiple floors.

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Q: How do you encourage your HM physicians to do that?

A: I don’t have to. They do it. We have found it very valuable, and in our place, it’s led to better outcomes. That means better patient care.

Q: Can you give an example of that value to the institution?

A: We initiated a rapid-response program several years ago we call “Triggers.” When a patient displays certain symptoms—changes in heart rate, blood pressure, oxygen saturation, etc.—there is an automatic trigger that calls in a senior nurse and a senior attending physician. We have already demonstrated a reduction in fatalities and a reduction in mortality rates because of this. We have so few codes right now on our on floors that we had to move our codes to our simulators because residents were not getting enough training. It’s a good problem to have.

Q: Do you see more physicians, hospitalists particularly, embracing technology in the hopes of improving care delivery and process administration?

A: Sure. We have a group of residents who created some type of Wiki with their work. I’m not even sure how it works; it just happens. I know there are some hospitals out there preventing this from happening. I think that’s just stupid. It’s a fear that something proprietary or private will be posted for everyone to see. I don’t particularly think it’s founded. We’ve all heard stories about someone who leaves a folder full of files on the subway. Are we going to stop people from riding the subway?

Q: What do you think HM’s outlook is?

A: I think it’s bright. I’m kind of new to medicine. I’ve only been here about eight years. I kind of wonder what used to happen before hospitalists. I guess primary-care physicians came in early in the morning and late at night. That doesn’t sound like an efficient system to deliver care.

Q: What do you want conference attendees to take away from your words?

A: I just hope the stories I tell about process improvements help everyone in their institutions. It’s up to them.

Richard Quinn is a freelance writer based in New Jersey.


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