Archive for June 2008

The New (CMO) Math: Passion + Power = Progress

In his five years on the job, Dr. Ernie Ring taught me why the Chief Medical Officer role is crucial, and how to do it right. Since Ernie is retiring at week’s end, it seems like an opportune time to share what I’ve learned.A bit of background. UCSF Medical Center didn’t have a Chief Medical Officer until about 8 years ago; indeed, even today many U.S. hospitals lack a senior physician who is compensated by and works for the hospital. It is easy to understand why.Through several accidents of nature and politics, American hospitals have traditionally operated under two completely distinct organizational structures. The first, of course, is that of the hospital itself, with its governing board, a CEO and assorted senior administrators (the “C-Suite”), and a cast of thousands that includes nurses, pharmacists, social workers, billers and coders, and many more. The flavor is corporate and hierarchical; many members…

The Best and Worst of Times For “Infection Preventionists”

As I mentioned in my last post, these should be the best of times for "Infection Preventionists" (formerly known as Infection Control Officers). After years of trying to get someone – anyone – to pay attention to their work, their day in the sun has finally arrived. But they are far from a joyful bunch. Why?In my talk to 4,000 members of the Association for Professionals in Infection Control (APIC) last week, I riffed on this question. After being prepped like a pre-debate presidential candidate by my friends Amy Nichols and Barb DeBaun (thanks!), I told the group that they are going through the inevitable but unpleasant phase of being attention- and accountability-rich but resource-poor. In other words, now that healthcare-associated infection rates are key measures of safety (with real skin in the game in the form of public reporting and “no pay for errors”), infection control departments are under…

How Infection Prevention Came to Dominate the Patient Safety Movement

The Joint Commission just released its 2009 National Patient Safety Goals, and – no surprise – they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is one of the most surprising twists of the patient safety revolution.The inclusion – make that dominance – of infection prevention in the safety field was anything but preordained. The IOM Report on medical errors, which sparked the modern patient safety movement, mentions the word “infections” 8 times and the word “medications” 234 times. In other words, the Founding Fathers of patient safety didn’t appear to have preventing infections in mind when they articulated the scope of the endeavor.So how did it come to pass that infection prevention became one of, if not the, central focus of the patient safety enterprise? The first step was recognition of the importance of…

Announcing our Hospitalist CME Course, and a New Hospitalist Mini-College

A quick heads-up for those of you thinking about attending this year’s Management of the Hospitalized Patient (MHP) conference, October 23-25 in SF… we’re adding a hands-on, small group “Hospitalist Mini-College” pre-course. I think it will be tremendous.This will be our 12th Annual MHP conference (co-sponsored by the Society of Hospital Medicine). It is a clinical CME course, blending lectures on key topics in hospital medicine (I hand-pick the faculty for their lecturing skill) with nearly 20 small group session choices. We use the computerized Audience Response System to promote active learning, and there are great opportunities to network with (and recruit! – just not my faculty, please) the 500-600 hospitalist (and others interested in hospital medicine) attendees. Information about this conference, which takes place at the beautiful and historic Fairmont Hotel on Nob Hill, is here, along with the pdf brochure, which describes both courses.One thing we’ve heard over…

Could Intensivists Be Harmful to ICU Patients’ Health?

Of all the structural (how care is organized) “evidence-based markers of high quality care,” perhaps the most ironclad has been the involvement of critical care physicians in the care of ICU patients. That is, until now.In a sophisticated study in today’s Annals of Internal Medicine, Levy and colleagues mine a decade-old, 100-hospital, 123-ICU database containing detailed clinical data on more than 100,000 patients to examine the association between ICU staffing models and hospital mortality. The researchers tell us that they began the study expecting to confirm the benefit of intensivists (also called “critical care physicians”). It would have been odd to expect otherwise, since such a benefit has been seen in a number of prior, smaller studies (summarized here).Levy et al. were really seeking answers to two different but related questions. The first: in those ICUs (n=79, or 64% of the 123 ICUs) in which non-intensivist physicians sometimes called for…
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