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

Goode, Leslie D. MHS; Clancy, Carolyn M. MD; Kimball, Harry R. MD; Meyer, Gregg MD, MSc; Eisenberg, John M. MD, MBA

Academic Medicine:
Special Theme: Medical Errors: SPECIAL THEME ARTICLES

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.

Author Information

Ms. Goode is vice president, American Board of Internal Medicine (ABIM), Philadelphia, Pennsylvania; Dr. Clancy is director, Agency for Healthcare Research and Quality (AHRQ), Washington, D.C.; Dr. Kimball is president and CEO, ABIM Foundation, Philadelphia, Pennsylvania; Dr. Meyer is director, Center for Quality Improvement and Patient Safety, AHRQ; the late Dr. Eisenberg was director, AHRQ.

Correspondence and requests for reprints should be addressed to Ms. Goode, American Board of Internal Medicine, 510 Walnut Street, Suite 1700, Philadelphia, PA 19106; e-mail: 〈lgoode@abim.org〉.

The opinions expressed in this article are those of the authors and not intended to represent official policy of the American Board of Internal Medicine, the Agency for Healthcare Research and Quality, the Department of Health and Human Services, or the ABIM Foundation.

The authors gratefully acknowledge the help of Deborah Beryline, PhD, freelance technical writer, Daniel B. Wolfson, MA, executive vice president, the ABIM Foundation, and Eileen Hogan, MPA, project officer, Center for Quality Improvement and Patient Safety, AHRQ.

© 2002 Association of American Medical Colleges