By Susan Pingleton, MD, FACP, Master FCCP
When I attended the AAMC’s Integrating Quality meeting in Chicago last month, I was again impressed by how much things have changed in our field over the past decade; and the innovative approaches some academic medical centers are taking to ensure improved patient safety and quality of care. I’ve been in the field for more than 30 years and, without resorting to hyperbole, would have to say that quality and safety have been fundamentally redefined since the initial Institute of Medicine report.
This has been in response to external drivers, and has impelled those of us in academic medicine—indeed the entire health care team—to not only say, but demonstrate, that we are assiduous in our assurance of patient safety and quality of care. The field is fraught with new expectations, new terms—and relatively few models to emulate. Fortunately, the meeting held up some great examples.
One could generally be termed “new organization structures of quality,” structures designed to align quality and safety with institutional work. These fill what I perceive to be a gap between the need for oversight and the structures to provide it. I would also venture to say that academic medicine’s response to creating these structures has been slow but, with the influence of the AAMC, changing.
Representatives from the University of Texas, Houston, described their organization’s revamped leadership structure, which includes new positions in the Dean’s office and new Vice-Chairs of Quality for each clinical department. At an institutional level, a Vice-Dean of Quality and Safety emphasizes the institutions’ priority for quality and safety. Coordination of the Dean’s work with a Vice-Chair in each department holds promise for coordinating the work of quality across the institution.
This innovation is very important and a bit unusual for academic medicine. University administrations are usually slow to respond to the idea that we need to teach quality and safety alongside disease identification and care. By breaking down these silos, the folks at UT Houston are bringing real legitimacy to their efforts.
There were other notable “structure” initiatives, including a Fellowship for Quality and Safety at the Christiana Care Health System and a Chief Resident of Patient Safety and Quality Improvement position at the University of Nebraska. When organizational structure is aligned with work, we can really maximize outcomes.
One of the most impressive examples of aligning quality and education was a discussion of the exciting news about Part IV Maintenance of Certification (MOC). Representatives from the Mayo Clinic, Massachusetts General Hospital, and the University of Michigan described the current status of their institutional MOC. Rather than making individual physicians spend as much as 40 hours fulfilling Part IV MOC QI requirements, institutional MOC programs allow physicians to align their projects with their local organizations’ quality improvement efforts to fulfill their MOC requirements. Also, a physician’s supervision of resident QI efforts may count for MOC. While significant organization and resource issues must be addressed, institutional MOC would appear to be a win–win.
In my view, this is huge—a really big deal. After all, MOC requirements affect the majority of physicians. If we can find a way to integrate personal and institutional efforts, the initiatives will be more robust and our outcomes will be dramatically improved.
I was inspired and energized by these and other presentations at the meeting. The AAMC Integration of Quality meeting is at the forefront of the alignment of quality and eduation.