Efforts to keep hospital patients safe and continually improve the overall results of health care can't work unless medical centers figure out a way to get physicians more involved in the process.
"Physicians' training and perspectives on patient care make their contributions to improvement efforts essential," says Peter J. Pronovost, M.D., Ph.D., a Johns Hopkins patient safety expert and co-author of a commentary published in the Feb. 2 Journal of the American Medical Association. "But the work of improving quality currently rests primarily with hospital administrators and nurses, with physicians taking a peripheral volunteer role, often questioning the wisdom of these efforts."
The major obstacle to recruiting physician leaders to the safety movement, he says, is the failure of medical centers to professionally and financially compensate and reward physicians for spending time on quality-improvement projects. "Such projects take away from the time physicians spend treating patients and generating revenue," he says. "What's needed is a system that would support a portion of a doctor's time spent managing and standardizing quality of care on a particular unit, in a role similar to what now happens with nurse managers."
Pronovost, a professor of anesthesiology and critical care medicine at the Johns Hopkins University School of Medicine, and Jill A. Marsteller, an assistant professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health, note that studies show little evidence that hospital quality-improvement programs have improved patient outcomes, despite buy-in from top administrators and a push for accountability. "Hospitals will only begin to see progress if they get physicians to not just participate more but to assume leadership roles in quality improvement," Pronovost says.
Pronovost and Marsteller argue that the root of the problem is the "antiquated" relationship between hos
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Johns Hopkins Medical Institutions