Nearly five years ago, when Nasim Afsar, MD, SFHM, was launching her career as a hospitalist at the University of California Los Angeles Medical Center, she began to appreciate the importance of quality issues for the field of hospital medicine.
Dr. Afsar, who recently was elected to the SHM board of directors, says, "I realized that evidence-based medicine should be the standard of care in hospitals, but we were nowhere near where we should be in addressing that at a systemic level."
Believing that her medical training had not fully prepared her for quality work, Dr. Afsar attended the Advanced Training Program at Intermountain Healthcare in Salt Lake City. "With that foundation, my focus ever since has been on improvement initiatives," she says.
In the years since, Dr. Afsar's quality responsibilities have grown steadily. She is now associate medical director of quality and safety at UCLA, executive director for quality and safety in its department of medicine, and director of quality for neurosurgery. That means about 80% of her work week is devoted to quality improvement (QI). And while her time seeing patients is less, she says the "clinical work is what inspires and motivates me, gives me my best ideas, and keeps me grounded."
Among the more than 40 quality and safety projects she has implemented at UCLA is "The ABCs of Hospitalized Patients," a multidisciplinary checklist designed to reduce the risk of eight common hospital-acquired conditions. "Within three weeks of implementing it, we started seeing significant improvement in every area, and we have been able to sustain that," she says. In 2009, she implemented a systemwide QI curriculum for the residents and fellows at UCLA.
Dr. Afsar, chair of SHM's Hospital Quality and Patient Safety Committee, says HM is challenged to make these kinds of quality approaches the standard of practice nationwide.
"Different institutions are doing different pieces of the quality movement very well," and SHM and its leaders on the board need to find a way to disseminate those best practices and integrate them into hospital practice, she says. "There are no simple ways to do that, but we know there are a lot of solutions out there."