David Bernard, MD, now chief medical officer at Beth Israel, had been practicing medicine for 30 years when at age 50 he took a year’s leave of absence from Boston University and enrolled as Dr. Shulkin’s first fellow in 1994. Dr. Bernard, a nephrologist, was a vice dean in the school of medicine at Boston University Medical Center, a hospital vice president for clinical affairs, and a senior clinician in his specialty group.
Drs. Shulkin and Bernard left the University of Pennsylvania in 1999 to take the concepts of quality transparency to a higher level and formed DoctorQuality Inc. in Conshohocken, Pa. To continue their work, DoctorQuality funded the fellowship. In 2005 when Dr. Shulkin went to Beth Israel in New York, the fellowship was restarted as the Don Hoskins Quality Improvement/Patient Safety program and funded for five years with private philanthropy.
Modeled after graduate medical education, the fellowship is predominantly hands-on. Fellows work on real projects alongside professionals in management, quality, and safety.
Under the Hood
Giving trainees the inside view into the intricacies of how to change physician behavior and cultural issues in hospitals is the backbone of Beth Israel’s program. Fellows see what clinicians rarely see: the real-world complexity of hospitals, why there is so much inertia, and the reasons changing systems can be so difficult. Fellows learn how almost every hospital issue involves financial, personnel, facility, policy and political considerations. By allowing entrée into the executive offices, the fellow gets to hear the many different perspectives when people react to an issue.
“After a quality-improvement meeting, for instance, where people are positioning and requesting different things rather than taking action,” says Dr. Shulkin, “the fellow gets to hear the behind-the-scenes analysis—how executives sometimes label people and develop strategies to overcome some of these barriers.”
Understanding how administrators, directors of social work, or nurses, for instance, view situations and understand their culture helps the leader be more effective.
“To get both leadership and clinician buy-in, and to get leadership to motivate clinicians to participate in system changes, you also need to be politically savvy,” says Dr. Adelman. “Plenty of people resist change. The PSO needs to come off as sincere, passionate, and smart, and has to be able to answer people’s tough questions.”
It can take an ambassador’s touch to make headway in the traditional physician culture.
“The patient safety officers, the chief medical officers, often have to function as diplomats,” says Dr. Angood. “This physician engagement piece is one of the most complicated issues out there, and it arises because physicians historically are trained to be autonomous, to be independent, and to expect that institutions are there to serve them.”
—Latha Sivaprasad, MD, Don Hoskins Quality Improvement/Patient Safety fellow, Beth Israel Medical Center, New York City
One Hospitalist’s View
When Latha Sivaprasad, MD, current Don Hoskins fellow at Beth Israel, started her fellowship six months ago, she was astonished how little she knew about patient safety and quality. Although she felt she knew the day-to-day deficiencies in the hospital and on the front line—and despite having practiced in three other hospitals—she wasn’t prepared to learn what she hadn’t known she didn’t know.
“In my five years as a hospitalist, I knew very little about patient safety and quality—to my shock now,” she says. “Since I’ve been a fellow here, I realize how much I had been underutilized and how much more I could have contributed to making my respective hospitals run more safely.”