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A Campaign for Quality

Maureen Larkin, for HealthLeaders Media, March 6, 2008

I could start with a corny line about the power of the pen, but I'll spare you that for now. Instead, I'm going to share a story that gives me hope that medicine is an industry that not only can change--but is hungry for it.

Earlier this month, the Society of Hospital Medicine launched a letter writing campaign to express its discontent with a ruling made in December 2007 by the Office for Human Research Protections. The ruling stopped a Johns Hopkins University study that examined the use of checklists in intensive care units as a way to curb hospital infections. Days after the letter writing campaign began, the OHRP issued a statement that said it would no longer stand in the way of Michigan hospitals using the checklist, or any other quality improvement efforts that pose minimal risks to patients.

If you're a regular reader of this column, you know that I've written about the benefits of the "checklist study" before. Modeled after lists used in the cockpit of airplanes, the list is made up of common sense actions that when taken together can virtually eliminate a patient's chance of acquiring an infection. It's an easy way to remind caregivers of the small, but important steps they should take when treating patients--steps that are often overlooked when pressure mounts.

Hospitalists--who now number more than 20,000 in the United States--are intimately involved with quality improvement efforts, says Russell Holman, MD, president of SHM's board of directors. That's why more than 160 members of his organization were inspired to send letters to the OHRP and members of Congress, urging the reversal of the "checklist study" shutdown.

"We see ourselves as inpatient leaders of quality improvement, patient safety, and service," he says. "More and more inpatient care is falling under the umbrella of hospital medicine, so we're intimately concerned with the systems of care and how to best deliver quality and safety to the patients that we serve."

The checklist struck a chord with members of SHM, Holman says, because of the intricacies of medicine and the human condition. We all know that Americans are getting sicker each year--with many having multiple conditions that must be considered when they seek treatment. Therefore, doctors juggle multiple thoughts, and it's often the simple, common sense things that get put on the back burner.

"There are too many things to remember and too much complexity for us to not use a tool like a checklist," Holman says. "We should expend our intellectual power on things that are less straightforward and more unique to the individual patient."

Perhaps the most interesting thing about SHM's letter writing campaign is that it debunks the myth that physicians are reluctant to change--and therefore will derail quality improvement efforts that disrupt the status quo. In just a matter of days, more than 160 physicians decided that yes, they would advocate for change in our industry, potentially opening themselves up to scrutiny by nurses, caregivers, and patients. For those 160 physicians, it will be all worth it if we can provide Americans with safer healthcare.

Was it the 160 letters that changed the OHRP's mind? Holman says he's not sure what other influences the OHRP may have had, but he'd like to think SHM's efforts played a part in it.

"We hope it was a contributing factor to the reversal and the recognition that quality improvement work done in a hospital is very different than original research methodologies," he says.


Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at mlarkin@healthleadersmedia.com.

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