medical team meeting, doctors exam reports

Quality Improvement Movement in Healthcare

Quality improvement expert Dr. Kaveh Shojania to headline ICRE 2016; inspire a healthcare-wide shift towards enhancing patient care

Twelve years ago, when Kaveh Shojania, M.D. co-authored the best-selling book Internal Bleeding: The Truth Behind America’s Terrifying Epidemic of Medical Mistakes (an explosive look at the rampant errors endemic to modern medical care) the quality improvement (QI) movement in North America had only just begun to take shape.

An integral player in that movement, general internist Dr. Shojania – the opening plenary speaker for the upcoming 2016 International Conference on Residency Education, and the director of the Centre for Quality Improvement and Patient Safety at the University of Toronto – has since established himself as a foremost expert in evaluating and implementing evidence-based strategies for improving healthcare quality and patient safety, and has found himself at the centre of a rapidly growing field of healthcare scholarship.

While the QI movement is still relatively young, Dr. Shojania says he hopes to expand its reach during ICRE 2016, by inspiring an international group of medical educators, program directors/administrators, residents, researchers, policy makers and more to integrate and carry out systemic changes in their own practice related to the science of improvement.

Drawing from his extensive research background on quality improvement and patient safety – including roles as a former Canada Research Chair (2005 – 2013), and current Editor-in-Chief of BMJ Quality and Safety – Dr. Shojania’s plenary address will outline what strides have already been made in North American healthcare systems around quality improvement; and what more needs to be done.

“Traditionally, in medicine, what was most noble – and harmful – about how health care worked was that [physicians] were really supposed to be the best that we could be,” he explained. “This of course, was a noble aspiration, but the flipside was that there was such an impetus on knowing everything, and being the most skillful technician you could possibly be, that if anything bad ever happened to a patient, it was implied that you weren’t good, and that it was a personal failing.”

What the quality and safety movement has attempted to do on a high-level, said Dr. Shojania, is to begin to shift thinking towards recognizing that within a complex field such as healthcare, positive patient outcomes must be a result of a quality system, rather than just a result of a few outstanding individual physicians who work within particular institutions.

“You can only get so far by having a bunch of great individuals, unless you have systems in place to support those individuals,” he observed.

Creating quality systems in which talented physicians can thrive means a more intersectional level of healthcare improvement, where not only will positive patient outcomes increase, but physicians, themselves, will experience an enhanced and supportive professional environment.

This shift, said Dr. Shojania, has already begun to take place in a North American context:

Qualitatively, I do see clear signs of improvement. I’ve been on service, and have heard residents, during rounds admit in front of the whole room that they had made a mistake the previous night while on call – that would have been unheard of when I was a resident…. It is somewhat liberating to recognize that even if you’re doing the best you can do, but the system doesn’t support you properly, bad things can happen to patients. The appropriate response is to fix the system, and not to necessarily blame the individual taking care of the patient at the time. – Dr. Shojania

Between unprecedented health care costs, and significant public exposure over the last decade of many incidences of quality and safety issues within North American healthcare institutions, Dr. Shojania said that a movement towards quality improvement is crucial in the context of 21st century medical education.

“I think we’ve now reached the point where [we can’t have residents or fellows] emerge from training, and have it be the first time they ever hear about the idea that their performance might be measured.” He concluded, “I think we now know what we have to do; and the hope is that we’ll make a lot more progress over the next 10 to 15 years.”

This article is courtesy of the Royal College. To find out more about Dr. Shojania’s academic contributions and accolades, visit the plenary speakers’ page on the ICRE website.

Dr. Kaveh Shojania will deliver ICRE 2016’s opening plenary on Thursday, September 29, 2016 (16:00 – 17:30) in Niagara Falls, ON.

author: Melissa Nilan