Change is the buzzword these days – in government and current events around the globe. Change is surely occurring in our health care system but it proceeds with apparent geologic celerity. Meanwhile, talented, experienced, knowledgeable physicians and health care providers are becoming ever more frustrated, cynical and sarcastic, as a result of trying to work within a broken system. Some retreat into just doing the best they can while remaining dispassionate, and disengaged from administrative opportunities for becoming involved in the institutions where they work.
We are taught to develop our own personal quality agenda – always do your best and offer the patient the best possible care at all times. But what happens when the system we work in doesn’t resonate with this viewpoint? When the business of running a hospital or clinic and the quality patient care agenda collide? The challenge of our time is to engage physicians at all stages of their careers in the quality agenda, and to foster a shared concern for institutional quality with their own internal quality control. This shift – physicians engaged in a quality agenda – will definitely produce cultural change within our hospitals and clinics and is long overdue.
The tales of hospitals that have made very impressive changes with a patient-centered focus on quality care are recounted in Charles Kenney’s book The Best Practice: How the Quality Movement is Transforming Medicine. Each chapter details how a different institution adopted the ideal of quality process/outcome improvement and what the process of change looked like along the way. For some of us in practice, it is gratifying to read about physicians who effectively push the quality agenda firmly into the lead and how all good things follow this approach. Sometimes I wonder if it is too late to engage the cynical and burned out among us to participate in this quiet revolution. Yet each chapter identifies an unlikely hero who steadfastly believed in the possibilities of change in their hospital, and worked at staying on target with initiatives designed to reach the goal of providing quality care. Tempered radicals they are, with a hefty dose of moral courage. And hopefully their story will encourage and ignite the next group of physicians to pick up the torch and continue the effort.