Home From The Editor Changing the structure, not just the process, of patient care

Changing the structure, not just the process, of patient care

March 2005

Published in the March 2005 issue of Today’s Hospitalist

How big of a role will hospitalists play in quality improvement efforts?

In this month’s issue, we offer some clear signs of how “and why “hospitalists are uniquely qualified to take the helm of the quality-improvement movement, particularly when it comes to the pay-for-performance programs that are sweeping U.S. health care.

Winthrop Whitcomb, MD, one of the founders of the hospitalist movement, says that in his experience implementing a quality incentive program, hospitalists played a central role because they fundamentally change the structure of care.

Remind a busy outpatient physician to give a pneumococcal vaccine to pneumonia patients, and all you’ve changed is one part of a larger process. Hire a group of hospitalists to make sure that all patients are receiving that same vaccine, and you’ve changed the structure of care. It’s obvious which change is going to produce a greater effect.

Dr. Whitcomb says he’s certain that if hospitals continue to try to change processes of care “improving the use of drugs and procedures to reduce morbidity, for example “without addressing the underlying structure, many are going to fail.

Just as you wouldn’t try to drive a Model T 80 miles an hour down today’s highways, he says, you can’t necessarily expect old systems of care to meet some of today’s quality improvement goals. In some ways, though, that’s exactly what hospitals do when they use reminder systems and physician order entry software to try to improve quality of care.

Because hospitalists change the structure of care, they are in an excellent position to help hospitals reach quality-improvement goals. And that can only help the specialty cement its reputation in health care.

Edward Doyle

Editor and Publisher
Today’s Hospitalist