The ed­u­ca­tion of a safety spe­cial­ist

Modern Healthcare - - NEWS - By Meeri Kim

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.”

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