How to parlay quality improvement work into a star turn in academic hospital medicine

Hospitalists interested in getting ahead in academia learned about "Turning Quality Improvement into Academic Success" from Lakshmi Halasyamani, MD, associate chairperson of the Department of Internal Medicine at St. Joseph Mercy Hospital, Ann Arbor, Mich.; Anjala Tess, MD, a hospitalist in the Division of General Medicine and Primary Care at Beth Israel-Deaconess Medical Center, Boston; and Chad Whelan, MD, associate professor of medicine at the University of Chicago.

There are two paths to leveraging quality improvement (QI) work to success in academic hospital medicine: teaching and developing curricula regarding quality improvement and performing QI projects. Both paths have similar stages.

Before you launch a QI project, warned the presenters, know your local environment so your interests are aligned with the needs of the organization. Each hospital has different rules, and you should familiarize yourself with the tracks and how they work. If your goal is promotion, understand what it takes to be promoted.

Whatever your project or your career path, your QI work has to be shared with others. Dr. Whelan called this "making it count twice. For your work to be academic, you have to share it. It has to be shared outside of the classroom you're teaching in or the committee you're working in."

Working with the IRB

If you want to present or publish your work, it must go through your institutional review board (IRB). Dr. Whelan advised that you discuss your project with the IRB before you submit anything. Ideally, you should partner with an administrator in the IRB office to ensure you have help.

"Work with [the IRB] instead of working against it," advised Dr. Whelan. "Being nice to the IRB support staff makes a difference. And don't be intimidated by the forms."

Disseminate Your QI Work

There are lots of ways to share your work, but presentations and publications will always be noticed. In ascending order of "counting more", said Dr. Whelan, options include: posters, posters with published abstracts, posters with oral presentation, seminars, review articles, and publications of your original work.

Dr. Whelan asked session attendees where they had published and presented work. Responses included:

• Regional meetings of the American College of Physicians, the Pediatric Academic Society, and the Chicago Patient Safety Forum;
• National meetings including the Society of General Internal Medicine, the American Academy of Family Physicians, the American Society of Bioethics and Humanities, the American Heart Association, and the Veterans Administration; and
• Articles published in the American Journal of Medical Quality, Journal on Quality and Patient Safety, and Quality and Safety in Health Care.

Follow the Path

An example of a solid dissemination pathway is to first share your project in the planning phase as a work in progress and let other people see it, and then complete the initial phase. At this point, consider submitting it as a poster presentation to the SHM Annual Meeting.

"To get a poster in here is a great opportunity to get initial work out there," said Dr. Whelan. "Then consider a need for any additional work. At the meeting, talk to people, listen to what they say, then regroup and rethink your work."

Once you're satisfied with your modifications, you can submit the work to a peer-reviewed journal such as the Journal of Hospital Medicine. At this point, you may be able to present your work at a national meeting.

"So with one project, you have three opportunities to share it," Dr. Whelan pointed out.

He wrapped up the session by saying: "Curriculum development and hospital-based improvement initiatives really can lead to academic success. Don't be afraid to make it count as many times as you can. If it's important to your institution, it's probably important to others as well."