MAY 2003
Volume 27 • No. 5

Q & A explains new policies for consent to photograph

SHC responds to SARS with protocols based on latest information

Physicians needed to serve on SHC's medical staff committees

Stanford aims for comprehensive cancer center status

President Bush taps Martha Marsh to serve on advisory council

Internal medicine chief puts a priority on quality improvement

Match Day 2003

Internal medicine chief puts a priority on quality improvement

Peter Rudd's work on quality improvement has taught him a few things about group interaction and problem-solving. Mostly, it has taught him that improving health-care delivery is a process rather than an event. "People have to realize that no matter how smart they are, their first solution usually won't be the best one," says Rudd, professor of medicine and chief of the division of general internal medicine. "Improvements occur in stages. You make a few changes, measure the impact, make a few more changes, and continue the process over time."

Among the lessons Rudd has learned:

Start with small, narrowly defined projects in which team members can succeed and build confidence. Then move on to more ambitious projects.

Collaboration and input from several disciplines is crucial.

All team members must feel acknowledged and listened to.

Rudd knows what he's talking about. In addition to being director of the Department of Medicine's quality-assurance and quality-improvement programs, he is an active member of SHC's care review and quality improvement committees. He joined Stanford's faculty in 1977 as an assistant professor of medicine.

"Peter is one of the few physicians who really understand quality-improvement methods and how to change care processes for the better. That's no small task," says Joseph Hopkins, associate chief of staff, who has worked with Rudd in that role and as a fellow member of the hospital's quality improvement and care review committees.

Born and raised in New York City by two physician parents, Rudd studied French at Amherst College and once aspired to be a French professor. He ultimately enrolled in medical school at Case Western Reserve University, receiving his MD in 1970. "I saw medicine as an opportunity to engage with people and learn new things every day," Rudd says. He chose internal medicine, doing his internship and residency at Stanford, because he liked the idea of a long-term connection with patients.

While in medical school, Rudd did a rotation on an Indian reservation in New Mexico, an experience that taught him how culture affects people's attitudes toward medical care. Between his internship and residency, he worked with other recent physician graduates, providing care to Hispanic and Filipino migrant farmworkers in Delano, Calif., and helping plan and design a clinic for this underserved population. "It was great because we were working for a cause we believed in," Rudd says.

But the experience also made him realize he lacked practical health-planning skills. That led him to pursue a clinical planning fellowship through the Robert Wood Johnson Foundation. The program "addressed how to think through priorities despite constrained resources and get the best possible outcomes," Rudd says. It sparked his interest in health-care quality, an area in which he's continued to work, recently by participating in a leadership training program sponsored by the California Health Care Foundation.

Rudd has directed or participated in a handful of quality-improvement projects at Stanford. A project he's now leading , for example, seeks to enhance clinicians' use of less traditional interventions for community-acquired pneumonia, including pneumococcal vaccination and smoking cessation, among patients admitted to Stanford Hospital.

Rudd notes that there's an important distinction between "quality assurance"- a reactive process that responds to adverse events by examining what went wrong-and "quality improvement"- a proactive endeavor aimed at improving average patient outcomes for common procedures or conditions. Rudd believes that more emphasis should be placed on quality improvement. "The question we should ask is, 'How can we be the best we can be?' instead of, 'How can we be good enough to avoid making a mistake and getting criticized?'"

One of Rudd's goals is to make quality-improvement efforts more attractive and manageable for physicians, who "often are so swamped that they don't have much time for QI." The answer, he says, is to create small but meaningful QI projects where doctors can see the positive impact of their efforts and will then be encouraged to join larger projects. "By taking ownership of health-care quality," he says, "we can make things better because it's the right thing to do, not because someone is looking over our shoulder."