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Point With Pride, View With Alarm, End With Hope

Nash, David B. MD, MBA; Goldfarb, Neil I.

doi: 10.1097/ACM.0b013e3181c666e1
From the Editor: Quality and Safety in Medicine

Dr. Nash is dean, Jefferson School of Population Health, Philadelphia, Pennsylvania; Mr. Goldfarb is associate dean for research, Jefferson School of Population Health, Philadelphia, Pennsylvania.

Editor's Note: Ten years ago, the Institute of Medicine released its seminal report on medical errors, To Err is Human. To commemorate that landmark publication, this month's journal is entirely devoted to articles on quality and safety in medicine. Dr. David Nash and Mr. Neil Goldfarb, who wrote the first essay below, served as guest editors for the articles that were responses to the journal's call for papers on the topics of quality and safety. Dr. Carl Patow served as the guest editor for additional articles that discuss aspects of a national initiative sponsored by the Alliance of Independent Academic Medical Centers, which he describes in the second essay below. I thank all the guest editors for their extensive efforts in assembling this month's articles and for working with Anne Farmakidis and Al Bradford and other members of the journal's professional staff to prepare them for publication.

–Steven L. Kanter, MD

Our nation has grudgingly come to recognize that the health care status quo is unsustainable. Indeed, we cannot solve our current economic crisis without solving our health care delivery crisis. Upon closer examination, our nation must embrace four critical pillars for health care-system change: the creation of value, the coordination of care, the reform of the payment system, and the provision of insurance coverage for everyone.

Is there any hope that such changes can be made? How do we go about making them? While our political leaders struggle with these issues, a quiet but growing revolution of sorts is taking place in our academic health centers (AHCs). Leaders from our most prestigious institutions are calling for those of us who provide care to return to our “historic routes by focusing on the long established mission of improving the health of the public … the most fundamental and most socially responsible mission for academic medicine is working to improve the health for all.”1

A growing chorus of voices, from across all of organized medicine, has collectively spoken out about the crucial need for better care. Astute observers have noted that “unless everyone who works in health care recognizes that they have two jobs when they come to work everyday, i.e., doing the work and improving it, ”2 we will have difficulty maintaining and nurturing our true professionalism, namely continuously moving toward new and better levels of performance.

There is more hope. A major national report3 has noted that all medical schools should ensure that “students become familiar with critical subject matter, including knowledge and skills for improving the quality of patient care and enhancing patient safety.” Others have outlined a bona fide career pathway4 (in AHCs) devoted to just these newly emphasized skill sets of quality and safety.

Enter now this special issue of Academic Medicine, demonstrating without a doubt that many AHCs do, in fact, “get it.” We who carry out the work of AHCs are capable of providing the leadership to achieve our new mission. We can embrace a new professionalism that calls for continuous improvement, and we are already successfully carving out a career trajectory for future leaders in this arena.

With contributions from across the country, this special issue highlights such efforts as engaging trainees in the gut-wrenchingly difficult work of self-evaluation, linking decision support tools to patient-level clinical improvement, decreasing mortality by embracing the tenets of evidence-based practice, and effectively implementing formal teamwork strategies to improve medication safety.

The articles in this issue provide growing evidence that the scholarship of quality and safety measurement and improvement is maturing.5 More is on the horizon with the development of educational programs at the master's level among our members,6,7 the proliferation of simulation centers where trainees are exposed to team-based, interprofessional training in quality,8 and the ready availability of key curriculum materials online under the auspices of the Institute for Healthcare Improvement and others.9

We would like to thank Dr. Steven Kanter, the editor of Academic Medicine, for giving us the opportunity to serve as guest editors for this special issue. Our original call for papers yielded over 130 submitted abstracts, further evidence of the growing groundswell of quality- and-safety- related activities in AHCs. As the nation's second master's program in quality and safety begins,6 we look forward to the continuing efforts of the academic medicine community to identify and disseminate best practices for quality and safety improvement, and to educate the next generation of practitioners on this important topic.

David B. Nash, MD, MBA

Neil I. Goldfarb

Dr. Nash is dean, Jefferson School of Population Health, Philadelphia, Pennsylvania; Mr. Goldfarb is associate dean for research, Jefferson School of Population Health, Philadelphia, Pennsylvania.

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1 Ramsey PG, Miller ED. A single mission for academic medicine: Improving health. JAMA 2009;301:1475–1476.
2 Batalden P, Davidoff F. Teaching quality improvement: The devil is in the details. JAMA 2007;298:1059–1061.
3 Cohen JJ. Chairman's summary of the conference. In: Hager M, editor. Revisiting the Medical School Educational Mission at a Time of Expansion, 2008; Charleston, SC. Josiah Macy Foundation; 2008.
4 Shojania KG, Levinson W. Clinicians in quality improvement; A new career pathway in academic medicine. JAMA 2009;301:766–768.
5 Patel K, Nash DB. The scholarship of quality. Jefferson Health Policy News Letter 2008;21:1–2.
6 Jefferson School of Population Health, the Masters Program in Health Care Quality and Safety. Available at: Accessed September 25, 2009.
7 Masters of Science in Quality Assurance and Regulatory Science. Available at: Accessed September 29, 2009.
8 Manser T. Team performance assessment in healthcare; Facing the challenge. Simulation in Healthcare 2008;3:1–3.
9 DerGurahian J. Lessons in quality, safety; Online school designed to augment medical education. Modern Healthcare April 13, 2009:32.
© 2009 Association of American Medical Colleges