Quality Improvement: We Are Not Alone

For the most part, we physicians are not the source of the errors. However, we can work with our colleagues (nurses, pharmacists, and others) to improve the medication dispensing/administration systems not only at the hospital, but in our offices as well. I doubt that there are any of us who have not experienced a drug administration error in our office. It is one thing to say let’s not do this again, but another thing entirely to look systematically into how the mistake occurred and change procedures to ensure it does not happen again. Although your individual action might not affect a large number of patients, if we all took these sorts of actions, we would have a very large impact just in the ambulatory setting.

Another level of participation is through the various otolaryngology organizations in the national arena. This month’s Special Report details the various quality improvement activities in which the American Academy of Otolaryngology-Head and Neck Surgery (based in Alexandria, VA) is involved. Among its many activities, the Academy represents the specialty to the myriad national organizations involved in quality improvement. In addition, the Academy involves many of its members in various committees and task forces that develop otolaryngology-specific measures of quality. The Academy seeks participation in these projects, so if you have interest, I suggest you contact the Academy for more information.

In my position with the American Board of Otolaryngology (based in Houston), I frequently give talks on Maintenance of Certification (MOC), a quality improvement program in which all otolaryngologists certified in 2002 and thereafter are required to participate. In my closing slide, I discuss the rationale for MOC. I point out that in otolaryngology, there are very few bad apples, doctors who are beyond remediation. The vast majority of otolaryngologists practice good medicine on most patients most of the time.

Like that of the MOC, the quality movement’s goal is to move our practices up a notch or two, so that we practice excellent medicine on all our patients all the time. Perhaps this is an unachievable, idealistic goal, but the closer we get to it, the better it will be for our patients and for us because, in the end, isn’t doing the best for our patients why we went into medicine in the first place?

I suppose another aspect of these changes that may make some wary of participating is the question, Will they work? Some changes will, and some will not, but waiting for the perfect solution is not an option. We physicians are in a unique position to participate in if not lead many of these initiatives. The health care quality improvement movement is moving forward very rapidly. The leaders of the various organizations desperately want physician involvement, but if we drag our feet too much, they will move on without us, in which case they will be driving the train, and we will be in the caboose.