Hospitalists Are Ideally Suited to Lead Quality Improvement

SAN DIEGO — The way Dr. Mark Novotny sees it, hospitalists are uniquely qualified to lead hospital-based quality improvement projects because they encounter inefficiencies on a daily basis such as missing lab specimens, lost chest x-rays, or a patient they've been asked to see who has been moved to another room.

“The inefficiency and waste of hospital processes are not just an observation on a spreadsheet, they're your day,” he said at the annual meeting of the Society of Hospital Medicine. “Those inefficiencies and waste in your day are multiplied by every other caregiver, and the patient. Most estimates are that 30% of health care dollars are completely wasted. That's a lot of money.”

A key factor to leading a quality improvement project is the willingness to accept accountability for managing resources, said Dr. Novotny, a hospitalist who is chief medical officer of Southwestern Vermont Health Care, a not-for-profit consortium of services based in Bennington, Vt. The goal of your project might be to align resources to accomplish performance improvement, reduce harm to patients, achieve reliable processes, or reduce waste of time and money. Whatever it is, “choose an issue about which you're passionate,” he advised. “Volunteer to lead a task force, understand the resources, and pick a measurable goal and time frame. Get the training you need to understand how to set a goal, measure, and improve.”

It also helps to “think like the administrators” in your practice setting and be able to articulate how the project will save money and improve quality. “The cost of poor quality is something that you can identify and take to the administrators for support of your project,” said Dr. Novotny, who became a physician leader after starting out as a general internist 26 years ago. “There are reimbursement issues that are now tied to quality measures. Find out what quality issues the administration is already worried about.”

He offered the following tips for leading quality improvement projects:

▸Use your clinical knowledge to bring forward system problems. “You know where the problems are out there,” he said, adding that efficient data capture and data management are common challenges in today's practice environment.

▸Acquire the performance improvement skills you need. Take the Society of Hospital Medicine's Quality Improvement Pre-Course, courses at the Institute for Healthcare Improvement or Intermountain Health Care, or learn the tools from your own quality department.

▸Find partners who will work with you and support your goal. These may include nursing leaders, the chief medical officer, the chief operating officer, or case managers. “They're out there, and they can advocate the goal that you have,” he said. “They don't have to work for you, but they can support your goal.”

▸Use the politics of your organization to help you. “To me politics means the informal organizational chart,” Dr. Novotny said. “It's knowing who has influence, and being able to anticipate who's going to get in your way at your next meeting. It's knowing how to move something through your organization using influential people.”

▸Get someone from finance on board with the project. “You can get a finance manager or the chief financial officer to look at your data or your proposal before you take the project to the next level,” he said.

▸Get somebody with experience in quality/safety issues to help you design the project. “I've only recently begun to understand how complicated this is, because most of the processes you work in are chaotic,” he said. “They need design to become standardized, and it's not easy.”

▸Learn to run a meeting efficiently. “When you do this well, people will come to your next meeting,” he said.

If your quality improvement project is successful, don't take sole credit for the success. “Always credit the team and be quiet,” Dr. Novotny said. “When you credit the team, they'll come back for more, and then you'll get something else done. If you credit yourself, your team feels devalued. That was your last group project.”

He acknowledged that the hardest part of spearheading a quality improvement project is balancing the amount of time you spend on it. Hospitalists “have so much energy and passion for this work that people are using their own personal time,” he said. “I don't think that's a sustainable model. People are going to burn out. Don't do this without resources. You need an administrative assistant or someone to help you. You need to negotiate” for those resources.

When starting a quality improvement project, 'choose an issue about which you're passionate.' DR. NOVOTNY

SAN DIEGO — The way Dr. Mark Novotny sees it, hospitalists are uniquely qualified to lead hospital-based quality improvement projects because they encounter inefficiencies on a daily basis such as missing lab specimens, lost chest x-rays, or a patient they've been asked to see who has been moved to another room.

“The inefficiency and waste of hospital processes are not just an observation on a spreadsheet, they're your day,” he said at the annual meeting of the Society of Hospital Medicine. “Those inefficiencies and waste in your day are multiplied by every other caregiver, and the patient. Most estimates are that 30% of health care dollars are completely wasted. That's a lot of money.”

A key factor to leading a quality improvement project is the willingness to accept accountability for managing resources, said Dr. Novotny, a hospitalist who is chief medical officer of Southwestern Vermont Health Care, a not-for-profit consortium of services based in Bennington, Vt. The goal of your project might be to align resources to accomplish performance improvement, reduce harm to patients, achieve reliable processes, or reduce waste of time and money. Whatever it is, “choose an issue about which you're passionate,” he advised. “Volunteer to lead a task force, understand the resources, and pick a measurable goal and time frame. Get the training you need to understand how to set a goal, measure, and improve.”

It also helps to “think like the administrators” in your practice setting and be able to articulate how the project will save money and improve quality. “The cost of poor quality is something that you can identify and take to the administrators for support of your project,” said Dr. Novotny, who became a physician leader after starting out as a general internist 26 years ago. “There are reimbursement issues that are now tied to quality measures. Find out what quality issues the administration is already worried about.”

He offered the following tips for leading quality improvement projects:

▸Use your clinical knowledge to bring forward system problems. “You know where the problems are out there,” he said, adding that efficient data capture and data management are common challenges in today's practice environment.

▸Acquire the performance improvement skills you need. Take the Society of Hospital Medicine's Quality Improvement Pre-Course, courses at the Institute for Healthcare Improvement or Intermountain Health Care, or learn the tools from your own quality department.

▸Find partners who will work with you and support your goal. These may include nursing leaders, the chief medical officer, the chief operating officer, or case managers. “They're out there, and they can advocate the goal that you have,” he said. “They don't have to work for you, but they can support your goal.”

▸Use the politics of your organization to help you. “To me politics means the informal organizational chart,” Dr. Novotny said. “It's knowing who has influence, and being able to anticipate who's going to get in your way at your next meeting. It's knowing how to move something through your organization using influential people.”

▸Get someone from finance on board with the project. “You can get a finance manager or the chief financial officer to look at your data or your proposal before you take the project to the next level,” he said.

▸Get somebody with experience in quality/safety issues to help you design the project. “I've only recently begun to understand how complicated this is, because most of the processes you work in are chaotic,” he said. “They need design to become standardized, and it's not easy.”

▸Learn to run a meeting efficiently. “When you do this well, people will come to your next meeting,” he said.

If your quality improvement project is successful, don't take sole credit for the success. “Always credit the team and be quiet,” Dr. Novotny said. “When you credit the team, they'll come back for more, and then you'll get something else done. If you credit yourself, your team feels devalued. That was your last group project.”

He acknowledged that the hardest part of spearheading a quality improvement project is balancing the amount of time you spend on it. Hospitalists “have so much energy and passion for this work that people are using their own personal time,” he said. “I don't think that's a sustainable model. People are going to burn out. Don't do this without resources. You need an administrative assistant or someone to help you. You need to negotiate” for those resources.

When starting a quality improvement project, 'choose an issue about which you're passionate.' DR. NOVOTNY

SAN DIEGO — The way Dr. Mark Novotny sees it, hospitalists are uniquely qualified to lead hospital-based quality improvement projects because they encounter inefficiencies on a daily basis such as missing lab specimens, lost chest x-rays, or a patient they've been asked to see who has been moved to another room.

“The inefficiency and waste of hospital processes are not just an observation on a spreadsheet, they're your day,” he said at the annual meeting of the Society of Hospital Medicine. “Those inefficiencies and waste in your day are multiplied by every other caregiver, and the patient. Most estimates are that 30% of health care dollars are completely wasted. That's a lot of money.”

A key factor to leading a quality improvement project is the willingness to accept accountability for managing resources, said Dr. Novotny, a hospitalist who is chief medical officer of Southwestern Vermont Health Care, a not-for-profit consortium of services based in Bennington, Vt. The goal of your project might be to align resources to accomplish performance improvement, reduce harm to patients, achieve reliable processes, or reduce waste of time and money. Whatever it is, “choose an issue about which you're passionate,” he advised. “Volunteer to lead a task force, understand the resources, and pick a measurable goal and time frame. Get the training you need to understand how to set a goal, measure, and improve.”

It also helps to “think like the administrators” in your practice setting and be able to articulate how the project will save money and improve quality. “The cost of poor quality is something that you can identify and take to the administrators for support of your project,” said Dr. Novotny, who became a physician leader after starting out as a general internist 26 years ago. “There are reimbursement issues that are now tied to quality measures. Find out what quality issues the administration is already worried about.”

He offered the following tips for leading quality improvement projects:

▸Use your clinical knowledge to bring forward system problems. “You know where the problems are out there,” he said, adding that efficient data capture and data management are common challenges in today's practice environment.

▸Acquire the performance improvement skills you need. Take the Society of Hospital Medicine's Quality Improvement Pre-Course, courses at the Institute for Healthcare Improvement or Intermountain Health Care, or learn the tools from your own quality department.

▸Find partners who will work with you and support your goal. These may include nursing leaders, the chief medical officer, the chief operating officer, or case managers. “They're out there, and they can advocate the goal that you have,” he said. “They don't have to work for you, but they can support your goal.”

▸Use the politics of your organization to help you. “To me politics means the informal organizational chart,” Dr. Novotny said. “It's knowing who has influence, and being able to anticipate who's going to get in your way at your next meeting. It's knowing how to move something through your organization using influential people.”

▸Get someone from finance on board with the project. “You can get a finance manager or the chief financial officer to look at your data or your proposal before you take the project to the next level,” he said.

▸Get somebody with experience in quality/safety issues to help you design the project. “I've only recently begun to understand how complicated this is, because most of the processes you work in are chaotic,” he said. “They need design to become standardized, and it's not easy.”

▸Learn to run a meeting efficiently. “When you do this well, people will come to your next meeting,” he said.

If your quality improvement project is successful, don't take sole credit for the success. “Always credit the team and be quiet,” Dr. Novotny said. “When you credit the team, they'll come back for more, and then you'll get something else done. If you credit yourself, your team feels devalued. That was your last group project.”

He acknowledged that the hardest part of spearheading a quality improvement project is balancing the amount of time you spend on it. Hospitalists “have so much energy and passion for this work that people are using their own personal time,” he said. “I don't think that's a sustainable model. People are going to burn out. Don't do this without resources. You need an administrative assistant or someone to help you. You need to negotiate” for those resources.

When starting a quality improvement project, 'choose an issue about which you're passionate.' DR. NOVOTNY