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Performance Improvement
Raymond GAETA
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As an important part of our efforts to provide outstanding care to our patients, Stanford Hospital & Clinics has launched the 2003-04 Performance Improvement and Patient Safety Plan, which will be implemented throughout the organization in the coming weeks and months. We as physicians should take an active role in this initiative, as it offers us a valuable opportunity to improve patient care by applying our clinical knowledge and experience.
This initiative has been established to respond to the needs of our patients in tangible, measurable ways with periodic reporting to the medical board. The board has the responsibility for the delivery of medical care within the hospital, and the new plan represents a move to a more physician-based performance improvement strategy - an approach that is in keeping with good medical practice. A key component of the plan is the newly constituted Quality Improvement and Patient Safety Committee, which will have strong representation from the medical staff. The committee, which replaces the Quality Improvement Steering Committee, will be headed by associate chief of staff Joseph Hopkins and will have support from the Quality Improvement and Patient Safety office directed by Brenda Fischer.
It's important to note that the priorities of the Performance Improvement Plan flow from SHC's strategic goals: providing excellent quality care, excellent service and excellent financial performance. Specifically, the priority areas where we are seeking to standardize and improve care are:
Psychosis
Acute
myocardial infarction
Community-acquired
pneumonia
Providing
open access at Stanford's outpatient clinics
These priority areas have been identified through analyses of internal and external data, with special attention given to high-risk, problem-prone and high-volume conditions. Beyond these priority areas, the Performance Improvement and Patient Safety Plan identifies four cross-functional "critical focus areas" that we will be working on in all clinical departments. They are:
Pain
management
Medication
management/safety
Infection
control
Treatment
of behavioral emergencies
An important aspect of this new program is that we as physicians will help prioritize the specific issues to be worked on. We will also help put these issues in the appropriate medical context so that improvements implemented in one area or department can be expanded across our institution, thus producing a ripple effect.
Another key feature of the Performance Improvement Plan is that we will use a new model to identify, measure and address problem areas and implement improvements. This structured model, known as FOCUS-PDCA, is research-based and has been proven in many industries outside health care. Using this model, along with other tools, will provide us with benchmarks through which we can continually monitor ourselves. Thus, improvements in processes and care can be documented and continually maintained through periodic measurement.
Finally, the performance improvement projects we implement will be tracked so there is clear accountability for continued progress and ultimate completion. It has been suggested that when completed these initiatives be disseminated across the medical center in addition to being presented to the medical board. In the coming months, look for reports in Medical Staff Update as the Performance Improvement Plan produces improvements that make a real difference in patient care and safety.
I want to emphasize again that this is moving forward as a physician-led initiative. As new Performance Improvement physician-led projects are now under way, medical staff members are encouraged to participate. Those with specific interests should contact chief of staff Larry Shuer or incoming medical staff president Bruce Adornato. For further information on the Performance Improvement and Patient Safety Plan, contact Brenda Fischer, director of quality improvement and patient safety, at 736-2191 or at bfischer@stanfordmed.org.
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This represents my final column as medical staff president. I have appreciated the support of the Stanford medical community over the past two years as we have striven to adapt to an ever-changing medical environment. Bruce Adornato assumes the presidency as of Sept. 1, and I know all of us will offer him our support in the coming years.
Contact Dr. Gaeta by phone at (650) 725-5352
