Quality improvement is something that UMASS Memorial Medical Center (UMMMC) has been focusing on since 2007 when Robert A. Klugman, MD came on board as senior vice president, chief quality officer, and medical director of managed care. One of his main focuses was changing the existing role of physician quality officers (PQO) from the traditional role to a new and improved role.
At the time, the traditional PQO was responsible for a clinical department and there was a tremendous variation in the amount of work each one was putting into improving the healthcare system. This variation was one of the main reasons why Klugman wanted to change the existing structure.
"A key component is engaging clinicians in this type of quality improvement effort, and getting them on board with quality improvement work," says Klugman.
Klugman decided to focus on a multi-disciplinary role for PQOs in the quality department. The PQOs would focus on systems improvement and be centralized within one multi-disciplinary office rather than focus on their separate clinical departments.
Even now, two years after Klugman instituted the new PQO model, physicians, other facilities, and national organizations continue to show interest in this model.
"Our model has been very successful," says Klugman. "The PQOs are now highly regarded by their colleagues which has fostered increased engagement by the medical staff in quality improvement initiatives. This is a big challenge in every organization."
Traditional vs. new
Many facilities have the traditional model in place, where the chief medical officer handles medical staff issues, credentialing, and privileges and the chief quality officer dedicated to handling quality improvement issues. Both the chief medical officer and the chief quality officer report to the chief executive officer. It quickly became apparent to Klugman that this structure wasn’t working at UMMMC.
"The lone ranger can't really do the work, particularly in larger organizations, without the engagement of the medical staff," says Klugman.
Continuing with the traditional model, each clinical department is responsible for quality improvement work in its own department. The department chair appoints a person in charge of quality improvement, who may not have had formal training and works only in his or her own department. Quality improvement work is not coordinated or organized between departments.
Klugman saw two major problems with this model:
- Variability in the energy, effort, and guidance PQO received to accomplish tasks due to multiple quality departments that were not integrated
- Fragmentation in the division of work between departments
Klugman wanted to ensure that UMMMC's quality improvement work continued to evolve along side healthcare as it becomes more patient centered.
"There is really a major push to take care from the bedside, and the patient perspective, and disease perspective, rather than divide it up into which department best fits," says Klugman.
Klugman's model was devised to recruit physicians who wanted to work as a PQO and was not based on departmental assignment.
"The PQO would work for the department of quality, but not necessarily in the department related to their medical discipline," says Klugman.
PQO for hire, training, and work
Klugman and a selection committee made up of department chairs, nursing leaders, quality improvement experts, the chief quality officer, and the medical center president helped sort through the 25 in-house applicants for the PQO positions.
The PQOs were and are currently required to:
- Be practicing physicians to bring clinical experience to quality improvement work
- Have excellent interpersonal and team building skills
- Have experience with change management
- Resolve issues through consensus building
- Demonstrate a passion and commitment to improve clinical performance
From the 25 original applicants, seven were chosen. They came from surgery, internal medicine, pediatrics, pediatric emergency medicine, obstetrics and gynecology, family practice, and cardiology.
The PQOs were required to take four 2-hour sessions of Quality College. The Quality College is a program designed by UMMMC, to educate the physicians on quality and patient safety, says Klugman.
The PQOs are then assigned ongoing projects in quality improvement processes and work closely with members of infection control, pharmacy, nursing, radiology, and risk management.
PQOs are assigned tasks based on their particular interest, and which PQO is best suited for the job. For example a surgeon PQO would be assigned to the National Surgical Quality Improvement Program.
Making the change and continuing forward
Obstacles are always bound to arise during the implementation of a new process, and this was no exception.
During the initial implementation of the PQO model, there were some resistance from the departmental administration and some staff members, says Klugman. With the new model in place, department leaders would have less control over their PQOs because the PQO would now be reporting to the chief quality officer.
Now, two years later, staff members' reactions are a little different.
"In a recent quality meeting with all the departments of quality and administration, it was universal by all the chairs that this was a great model and a (huge) improvement from the traditional model," says Klugman. "The PQOs have been very visible as leaders, experts, and role models. They have been very effective in engaging other MDs in working on improvement of all of our big quality improvement initiatives like rapid response, national patient safety goals, and cardiac improvements."