My guess as to what comes next in the practice of HM is the progressive blurring of the artificial barriers among the ED, the wards, and the ICU. The reality is that hospitalists are increasingly involved in all three domains, providing emergency and critical care as much as they are standard ward management. I am pleased that we are now engaged in discussions with the American College of Emergency Physicians and the Society for Critical Care Medicine, looking for potential areas of collaboration in building the hospital of the future.
Quality and Patient Safety
In the past year, SHM’s mentored-implementation initiatives have continued to expand, now improving more than 100 clinical sites. In their own right, these initiatives are impressive. But the most impressive element is the philosophy that one cookie-cutter strategy is unlikely to work for all systems. Tailoring the strategy to the unique features of the system, under the guidance of a mentor/coach, is the brilliance that has defined SHM’s efforts. Further, it espouses the greater philosophical principle that we are our brother’s keepers.
For meaningful healthcare reform to come to fruition, quality improvement in isolation (i.e. a few ACOs here or there) will be insufficient, a point I made at the White House briefing on healthcare reform. It is the role of a physician society such as SHM to bring together the community of all hospital systems, removed from the mindset of competition, to ensure that what meaningful improvements are made in one system are replicated in others.
SHM has made the jump to the next level in advancing quality by securing resources for a full-time physician quality leader within the organization. The announcement of who this leader will be will follow shortly, though I am pleased that SHM’s commitment to quality and patient safety continues to expand.
But with quality today addressed, what do we do about tomorrow? How do we ensure that those physicians who will follow us (i.e. our current medical students and residents) are better prepared to enact meaningful quality and patient safety as a part of their careers? I am pleased with the work enacted by the Quality Education Committee, establishing a Web-based portal that will serve as the foundation for teaching medical students and residents the essential principles of quality and patient safety.
But meaningful learning requires a “coach,” an educator trained in the principles of teaching and applying these critical skills. To meet this need, SHM has joined forces with the Alliance for Academic Internal Medicine (AAIM) to develop a Quality and Safety Educators Academy, which will take place early in 2012. This academy will train hospitalists interested in teaching quality and patient safety to medical students and residents, using the product developed by the QIE committee as its substrate. The ancillary benefit, of course, is the integration of more hospitalists into the educational infrastructure, exposing students and residents to their potential mentors such that HM becomes a valued career in their minds.
HM’s persistent challenge is the harsh reality that not all hospitalists engage in quality and patient safety. To this end, I am pleased that SHM’s quality database, SQUINT, has come to fruition. While nascent in its development, this Web-based platform will enable those who have enacted quality initiatives to upload their project to a searchable database, further enabling other hospitalists interested in starting a QI project to quickly search for projects that are similar to their hospital’s size, structure, and needs.