When Is “Good Enough”? The Role and Responsibility of Physicians to Improve Patient Safety

Abstract

In September 2001, the Agency for Healthcare Research and Quality (AHRQ) and the ABIM Foundation jointly sponsored an invitational conference entitled "The Role and Responsibility of Physicians to Improve Patient Safety." The goal of the conference was to begin a national conversation focusing on the individual clinician's role and strategies physicians might employ to advance patient safety. The authors summarize the main themes and issues that emerged at the conference. The authors draw from work by the Institute of Medicine (IOM) to support the need for greater emphasis on quality improvement. To date, most of the work in this area has involved a systems-level approach, and physicians are often viewed as obstacles to improvement programs. By contrast, physicians may view population- or systems-based approaches to health care as interfering with the delivery of care to specific patients. The authors argue that physicians, individually and collectively, have a key role in quality improvement efforts, albeit a role that is yet fully defined. After reviewing successful examples involving physicians, the authors explore the major levers to achieve change-removing barriers, creating incentives, emphasizing collaboration, increasing education, and promulgating regulation-and summarize ten recurring themes, including both current and near-term opportunities, for physicians to exercise leadership in quality improvement and patient safety. Finally, they assert that even modest change can lead to substantial improvements, particularly if medical societies and the profession's standard-setting bodies work together.

Barriers and Strategies to Influencing Physician Behavior

“…Disagreement with Complexity inherent in the interventions in general intervention(s) 12 and/or specifically 3,9 Varied results 6 Lack of outcome expectancy 9 Difficulty generalizing study Lack of self-efficacy 9 findings across health care Lack of motivation 9,11 settings 6,9,11,12 Behavior External barriers to perform recommendations (eg, patient or environmental factors) 9,11 …”

“…Less discussion has focused on the role of the individual clinician, particularly the physician. 3 Physicians' decisions not only influence the health of their patients but also control between 70% and 80% of all health care dollars spent. 4,5 Thus, the ability to change physicians' practices could improve health care quality while controlling expenditures.…”

“…5,13 Physicians care profoundly about providing good patient care, albeit they are better at providing oneon-one care than at improving population health, whereas governing boards focus more on the health of a defined population. 3 Population-based health systems may be regarded by clinicians as interfering with the delivery of care to individual patients (ie, affecting clinical autonomy). 3,8 It is striking how little is known about the clinical and cost-effectiveness of interventions that aim to change the practice or delivery of health care.…”

“…3 However, as the IOM emphasized, pointing fingers at caring health professionals is both ineffective and counterproductive. 1 Suboptimal prescribing and the resulting poor quality of care often results from inadequate information rather than from bad behavior.…”

A Model Framework for Patient Safety Training in Chiropractic: A Literature Synthesis

“…participation by organization's members,34,68 training support and reward structure,34,35,38,41,49,60,64,68 and evaluation22,44,48,55 (Table 1).…”