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Limits on Duty Hours Main Topic at GRA Meeting Post 9/11 Fallout: International Students, Patients Still Facing Scrutiny Organ Transplantation: Modern Triumphs and Tribulations Innovations in Medical Education: Spinning a Web in Simulation Current & Choice: Filling the Pipeline A Word From the President: Bridging the Quality Chasm Viewpoint: What We Are Learning From SARS
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A Word from the PresidentBridging the Quality Chasm
We stand by statements like that as a source of pride, indeed as an article of faith. Certainly, our research and education missions are powerful engines for improving the quality of tomorrow's health care. By providing the new knowledge indispensable for advances in prevention, diagnosis, and treatment, as well as by educating the workforce needed to implement those advances, academic medicine offers a wellspring of hope for improving the quality of health care for the future. But, as highlighted by the IOM's landmark report Crossing the Quality Chasm, A New Health System for the 21st Century, quality problems of a more immediate nature plague our system and demand urgent attention. The AAMC has embarked on several recent initiatives in response to this call to action. One is specifically responsive to the Chasm report's emphasis on transparency in health care. Last December, the AAMC, along with the American Hospital Association and the Federation of American Hospitals, announced an effort to demonstrate our commitment to healthcare improvement by reporting institution-specific quality measures directly to the public. This effort calls on hospitals to voluntarily post on a public Web site certain quality-of-care data elements, most of which are already being collected as part of the hospital accreditation process. All Council of Teaching Hospitals (COTH) members are being urged to participate in this groundbreaking national initiative, and many have already pledged to do so. The demand for public reporting of quality data is growing daily, and our hope is that this private-sector initiative will demonstrate our community's readiness to be openly accountable for the care it provides. Moreover, if successful, this effort could foster a national strategy for quality measurement and spawn a much-needed, uniform system for displaying easily understandable and reliable information. A second AAMC initiative in the quality arena resulted in a report published last February on patient safety and graduate medical education (GME). Authored jointly by the AAMC's Group on Resident Affairs (GRA) and Organization of Resident Representatives (ORR), this report articulated the educational opportunities as well as our professional and ethical responsibilities to improve patient safety. Intended both to inform the public and to guide those responsible for GME, it called upon residency program directors, residents, and faculty to make medical errors and their reduction an explicit part of residents' education, and suggested how patient safety could be addressed in the context of the ACGME's six competencies. A third AAMC initiative focuses on a much more fundamental problem - the very design of care delivery in clinical settings where our members treat patients and teach students and residents. As the quality guru W. Edwards Deming said, every system is designed perfectly to yield the results it produces. Our current system, designed for a simpler era that dealt primarily with acute, episodic illness, has ceased to be adequate to the task. In the present era, with its added, heavy burden of chronic disease and disability, and its abundance of complex, expensive, and risky technologies, our present outmoded system is clearly not producing the quality and cost-effective results we desire. Tinkering with an outmoded chassis will not suffice; what's required instead is a thorough restructuring of the way we deliver care. With proper support and dogged commitment, collaborative efforts by multiple academic medical centers could begin to model, at a convincingly large scale, the kinds of multi-disciplinary, patient-centered, evidenced-based care that we know are necessary in this new era. In addition to fostering near-term improvement in healthcare delivery, such efforts would greatly benefit our education mission by creating learning environments for healthcare professionals that embody established principles for ensuring optimal clinical outcomes. To catalyze the envisioned changes, the AAMC has entered into a strategic partnership with Don Berwick's Institute for Healthcare Improvement (IHI). Two collaborative projects are planned for the initial phase of this partnership, both of which will be directed by David Stevens, M.D., currently AAMC vice president for the Division of Medical School Standards and Assessment. The first project focuses on redesigning the work of all those involved in the clinical settings where students and residents learn their doctoring skills. The goal is to improve patient care, reduce medical errors, and enhance the quality of education. The second project aims to implement better and less expensive care for patients with chronic illness and builds on the ongoing efforts of several academic medical centers that have been meeting under AAMC auspices for the past year to explore a collaborative approach to achieving this goal. In fulfilling its commitment to be a positive change agent for academic medicine, the AAMC will continue to strengthen its portfolio of healthcare improvement initiatives. By marshalling their incomparable capabilities and talents, medical schools and teaching hospitals are in a unique position to lead our country across that yawning quality chasm. Editor's note: The GRA-ORR report can be viewed at www.aamc.org/publications/patientsafetygme.htm.
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