Think Globally: Quality and Safety in American Medicine

The FDA has also stepped in and now requires bar coding on certain drug and biological product labels and that reports on actual and potential medication errors be submitted to the agency within 15 calendar days, said Dr. Shine. It has also created a Safety Center-although I think it can do more, especially in the area of drug names and packaging.

Increasingly, disease management programs are playing a role in terms of improved quality because they emphasize a team approach, continued Dr. Shine. We do know that some of these programs can improve outcomes and possibly decrease costs. However, I am worried that the increasing commercialization of some disease management programs, and their methods and motivation for cost reduction, will affect overall quality. Additionally, some of these programs are attempting to care for patients without informing their physicians and this is a serious mistake.

Overcoming Obstacles

Obviously, there are going to be obstacles to crossing the quality chasm, such as physician disbelief, resistance to change, technology skepticism, and cost, said Dr. Shine. Fortunately, there are ways to overcome these challenges in order to achieve success, but they do require a change in mindset within our profession.

Characteristics of our profession in the 20th century included autonomy, solo practice, continuous learning, blame and shame, and knowledge, said Dr. Shine. We were annoyed by managed care, as it took away much or our autonomy. We placed a great deal of emphasis on continuous learning by requiring CMEs, only to find that this increased knowledge didn’t really translate into a change of physician behavior. We believed that this body of knowledge was sacred to our profession, but now anyone with access to the Internet can instantly obtain the same information as us.

Training the Next Generation

Medical students, residents, and young physicians of the 21st century must be trained to think differently. Teamwork is now and will continue to be required in all aspects of care. Fewer physicians work in solo practice; they must now interact within quality-improvement teams (like rapid response), unit-based committees, hospital-wide teams, task forces, and academic departments to solve problems. Some schools are beginning to bring together medical, nursing, pharmacy, and allied health students to learn together around case studies and standardized and simulated patients.

Since the focus is no longer ‘continuous learning’ but rather ‘continuous quality improvement,’ some specialties, such as internal medicine, have incorporated systems analysis as part of their residency review requirements to increase residents’ awareness of patient safety, said Dr. Shine.