Earlier this year, the Journal of the American Medical Association (JAMA) published the article “A Physician Management Infrastructure,” by Peter Pronovost and Jill Marsteller.1 Pronovost and Marsteller’s commentary gets to the very heart of the need for change in healthcare delivery and the major barriers to that change.
As they note, quality improvement (QI) continues to receive attention from every sector of the healthcare market, but systematic and widespread benefits—actual improvement in quality of care—are years away from reaching the patient. The major impediments to delivering performance changes at the front lines of healthcare are both attitudinal and structural.
However, such obstacles can be overcome, starting today.
The authors rightly cite the development of physician leadership as a significant factor in the long-term success of QI. For too long, healthcare leaders have taken a “learn as you go” approach to leadership development. This antiquated philosophy that the best physician leaders ascend naturally to leadership falsely assumes that today’s leaders are perfectly suited for their jobs.
Training Tomorrow’s Leaders Today
In order for meaningful QI to succeed, systematic leadership development in healthcare must be a priority. Those hospitals and healthcare systems that acknowledge this reality already are reaping the benefits. Across the country, more than 1,200 hospitalists have participated in SHM’s Leadership Academy, a rigorous multicourse program that trains physicians in the fundamentals of hospital-based leadership. Leadership Academy participants then go on to lead new programs, many of which are QI-related, in their hospitals. This year, SHM will announce a Certification for Leaders in Hospital Medicine, which will further raise the bar, and mentor, enable, and define the future leaders for our hospitals.
The collective experience of HM also indicates that formal mentorship programs are a critical element to systematic leadership development. The exponential growth of SHM’s mentor-based QI programs to reduce readmissions, prevent VTEs, and improve glycemic control in hospitals—now implemented in more than 300 hospital sites across the country—is a testament to the need for one-on-one mentorship and leadership development and the impact it can have on patient care.
SHM continues to provide broad training in performance improvement and patient safety in its one-day “Quality Improvement Skills” pre-course at the annual meeting (HM11, May 10-13, Grapevine, Texas, www. hospitalmedicine2011.org). In the coming months, SHM will debut a nine-part series of Web-based modules that are essential to any hospitalist now charged with taking an active role in improving performance at their hospital.
Teamwork Is Key
Looking at the evolved present-day hospital, but more to the future, SHM and hospitalists recognize that empowered and coordinated teams of health professionals will deliver the best care. SHM is working to promote the development of high-performing teams (HPTs) with the rest of the Hospital Care Collaborative (HCC), which includes national organizations for nurses, pharmacists, case managers, medical social workers, and respiratory therapists. SHM also has convened a senior group from C-suites, nursing executives, and the American Hospital Association; the plan is to publish a roadmap to promoting the growth and success of HPTs.
All the good intentions and teams and physician champions will still be hamstrung to affect real change in the current payment system, which still rewards healthcare in a transactional fashion, where we pay by the unit of the visit or the procedure. That is why SHM has taken our message to Washington and why we are supporting innovations that reward performance.
The value-based purchasing initiatives that will move substantial dollars to those hospitals that show they can deliver better performance (we’re talking millions of dollars, even at the start) is a beginning of hopefully a sea change in how we think about paying for healthcare (see “Value-Based Purchasing Raises the Stakes,” p. 1). And SHM continues to actively promote having national hospitalist thought leaders be right in the middle of setting the new standards of healthcare at the National Quality Forum, the Joint Commission, and AMA’s Physician Consortium on Performance Improvement, along with other national organizations.
Dr. Pronovost sees the gaps and barriers in having a management structure at our nation’s hospitals that is staffed, financed, and trained to deliver high performance. He does specifically call out hospitalists as a new specialty that is better organized to potentially be part of the solution. SHM and our hospitalists want to move this from a possibility and a potential to affect real change, consistently, day after day, at as many hospitals as we can reach. That is the promise of hospital medicine, and that is the vision of SHM. TH
Dr. Wellikson is CEO of SHM.
- Pronovost PJ, Marstellar JA. A physician management infrastructure. JAMA. 2011;305(5):500-501.