The education of a safety specialist
Although he already had a departmental leadership role at an esteemed medical school, OBGYN physician Joseph Montella had career ambitions that aimed higher. He coveted an administrative position in a hospital C-suite.
As the director of quality and safety for the OB-GYN department at Jefferson Medical College in Philadelphia, Montella felt that an advanced degree other than an MBA would help him stand out from the pack. He chose a then 5-year-old quality-and-safety master’s degree program at Thomas Jefferson University’s School of Population Health. He graduated in 2014.
Today, he’s vice president of medical affairs at Cooper University Health Care, based in Camden, N.J., on the other side of the Delaware River. His responsibilities include developing agendas for quality and safety at the organizational level—a position he feels puts him on a clear path to oneday ascending to the C-suite.
“In addition to learning all the tools and methods of quality and safety, we had some great courses on organizational development and how to run projects,” said Montella. “You really have to be flexible and fast in this field, and that’s what the program taught me.”
The program Montella attended is one of a handful that academic medical schools have created in recent years that focus specifically on patient quality and safety. These master’s and Ph.D. programs are designed to train midcareer physicians, nurses, pharmacists and other healthcare professionals to take leadership roles in transforming the quality of care offered at hospitals and other care sites.
For years, providers in their efforts to respond to the call for better outcomes and fewer medical errors relied on sending their key personnel to conferences and workshops. Some would enroll in single courses or limited certificate programs.
But in the past decade, a growing number of schools— including renowned institutions such as the University of Toronto, Northwestern University and George Washington University— have created more rigorous graduate programs for midcareer professionals. Not only are they responding to the burgeoning patient-safety movement, but also the financial incentives the CMS created to improve quality and safety that followed in the wake of the groundbreaking 1999 Institute of Medicine report, To Err is Human: Building a Safer Health System.
That report documented the widespread prevalence of medical errors that shocked both the healthcare industry and the nation. Its analysis of multiple studies revealed that between 44,000 and 98,000 people die each year as a result of preventable medical errors, a number that more recent reports may be even higher.
The report pushed for a minimum 50% reduction in errors by implementing sweeping, systemwide changes. Along with a 2001 companion report, Crossing the Quality Chasm: A New Health System for the 21st Century, the reports galvanized providers’ attention to the issues of unnecessary medical errors, patient safety and healthcare quality. It spawned a patient-safety movement and created the widespread public consciousness that medical errors could no longer be swept under the rug.
“In addition to learning all the tools and methods of quality and safety, we had some great courses on organizational development and how to run projects.” Dr. Joseph Montella Director of quality and safety OB-GYN department Jefferson Medical college
That led to a rise in demand for professionals with the managerial skills and expertise to improve quality and safety at health systems. Many major hospitals have created dedicated leadership positions for such experts.
A search of Modern Healthcare’s not-for-profit executive compensation database shows 306 healthcare organizations reported highly compensated individuals holding positions managing quality and safety in 2013, up from 184 in 2012. Salaries ranged as high as $1.6 million a year.
“The demand for people to work in this area both in physician and non-physician roles is very, very high,” said Dr. Andrew Ziskind, managing director at Huron Consult-
ing Group. “In my experience, there is a shortage of good administrative and clinical leaders with an expertise in safety and quality.”
There are currently six programs in the U.S. and Canada that offer a master’s degree in healthcare quality and safety. The majority offer an online-only curriculum that allows the number of available of slots to expand based on demand. But the programs have strict admission criteria—like any graduate program.
The potential payoff for those who earn the new degrees is large. The most successful students—like Montella— have gone on to hold such titles as director of quality and safety, vice president of medical affairs, and chief quality officer. Salaries can vary considerably depending on the exact role, but chief quality/patient-safety officers earned an average of $375,000 per year in 2013.
But the question remains: Can graduate-level training in patient quality and safety play a significant role in helping to alleviate the medical error crisis?
Advocates for the new programs say yes. “(Traditional) medical education is stuck in a paradigm that is 35 years old, with a very modest emphasis on patient safety and quality,” said Dr. David Nash, founding dean of the Jefferson School of Population Health at Thomas Jefferson University in Philadelphia. “The way to reduce death and injury due to medical error is to have more people trained in these tools and techniques in order to advance the field.”
The Philadelphia-based institution’s online-based program began in 2009, culminating in a Master of Science in Healthcare Quality and Safety, or MS-HQS. Three years earlier, Northwestern’s Feinberg School of Medicine began offering a two-year, part-time, classroombased program for a master’s in the field, later adding the option of a combined MD/MS for medical students.
Since then, four more schools have made advanced degrees in the field available: University of Alabama at Birmingham, University of Illinois at Chicago, George Washington University, and the University of Toronto. In addition, Northwestern has just this year produced the nation’s first Ph.D. in healthcare quality and patient safety, with another doctoral student aiming to finish next year and more expected to enroll.
“Traditional academic medicine has been focused on basic research, but as we start to focus more on outcomes and clinical service results, it really helps to align that cultural shift around education programs in safety and quality,” said Ziskind at Huron Consulting. “This will start to make the field an academically worthy pursuit from a research perspective and also give it value from an organizational perspective.”
The controversial pay-for-performance programs introduced by the CMS have only heightened the urgency felt by hospitals to quickly implement quality and safety programs. Hospitals are now penalized for excessive readmissions or if they fall in the bottom fourth of hospitals in preventing hospital-acquired infections and complications.
“Every institution has to have someone who lives and breathes quality—whether it’s a patient-safety officer or a chief quality officer, someone needs to be responsible,” said Dr. Janis Orlowski, chief healthcare officer at the Association of American Medical Colleges.
Students who enroll in Jefferson’s program have an average age of 52—mostly physicians who seek a leadership role in order to help fix what they see as a flawed system. Currently, 60 individuals are enrolled in the online MS-HQS program from 30 different states and one foreign country.
The curriculum differs from school to school, with no official agreement yet on what core competencies master’s graduates should possess. However, courses generally include advanced, evidence-based knowledge on how healthcare quality is defined, measured and improved; common medical errors, methods of reporting errors and specific tools for prevention; the development of safety
Traditional “medical education is stuck in a paradigm that is 35 years old, with a very modest emphasis on patient safety and quality.” Dr. David Nash Founding dean of the Jefferson School of Population Health Thomas Jefferson University in Philadelphia
culture; and how public policy drives change.
“What I now see happening in the world of patient safety is the same thing I was seeing in health informatics—it’s moving toward a profession, a discipline,” said Dr. Annette Valenta, who runs the patient-safety leadership programs at the University of Illinois College of Medicine in Chicago. “The body of knowledge is becoming increasingly sophisticated and requires those kinds of conceptual frameworks, methods, and tools that are best learned in a graduate program.”
Despite welcoming the trend of deeper education in patient quality and safety, Valenta believes it could take a decade or longer before enough people in a given healthcare organization with adequate training will be able to make a difference. Given the winning concept of team-based care, a single person with a master’s degree hired by a hospital likely won’t be enough to make it a safer environment.
Others feel that a small number of healthcare professionals getting higher-level degrees may not be necessary at this point. Teaching the key tenets and procedures of safety to a larger group and disseminating that knowledge in a more widespread way could perhaps be a better approach.
“There are a number of programs where you teach quality improvement to your entire institution, such as Virginia Mason’s efforts to improve patient safety and quality of care,” said the AAMC’s Orlowski. “Do you need a certification or degree program for that, or do you need to train across the board at your institution? Probably the latter— you need more people having basic information, and we’ve seen people get that information without a degree.”
In Montella’s case, he believes the specialized training allowed him to make a difference in his new job as vice president of medical affairs at Cooper University Health Care. “I have created a program to embed quality into the reimbursement of physicians that we rolled out in January of this year, so they have skin in the game,” Montella said. “So far, there’s been a dramatic drop in central line-associated bloodstream infections and other patient-safety indicators.
“You don’t have a lot of time when your CEO comes to you and says ‘We want to reduce our infections,’” he said. “The program taught me how to focus on being very efficient when looking at a problem and coming up with a solution.”