Amid growing focus on individual physician performance, it is timely to examine what evidence exists that physicians can be facilitators and leaders for health care quality improvement in their local health care environments. Despite the importance of governmental policy and national initiatives, change in health care quality must occur in the context of local communities. Therefore, individual physician involvement, working with other local health care leaders and providers, will be crucial to future quality improvement. The objectives of this article are as follows: (1) outline why physicians must be involved in quality improvement, (2) delineate the barriers and facilitators to physician involvement, and (3) discuss how medical certification boards can facilitate greater physician involvement in quality improvement.
Audet AMJ, Doty MM, Shamasdin J, Schoenbaum SC. Measure, learn, and improve: physicians' involvement in quality improvement. Health Affairs. 2005;24:843-853.
2.
Meehan TP, Tate JP, Holmboe ES, et al. A collaborative initiative to improve the care of elderly Medicare patients with hypertension. Am J Med Qual. 2004;19:103-111.
3.
ABIM Foundation, American Board of Internal Medicine, ACPASIM Foundation, American College of Physicians–American Society of Internal Medicine, European Federation of Internal Medicine. Medical professionalism in the new millennium: a physician charter. Lancet. 2002;359:520-522.
4.
Blank L, Kimball H, McDonald W, Merino J. Medical professionalism in the new millennium: a physician charter 15 months later. Ann Intern Med. 2003;138:839-841.
5.
Becher EC, Chassin MR. Taking health care back: the physician's role in quality improvement. Acad Med. 2002;77:953-962.
6.
Brennan TA. Physicians' professional responsibility to improve the quality of care. Acad Med. 2002;77:973-980.
7.
Goode LD, Clancy CM, Kimball HR, Meyer G, Eisenberg JM. When is “good enough”? The role and responsibility of physicians to improve patient safety. Acad Med. 2002;77:947-952.
8.
Gruen, RL, Pearson SD, Brennan TA. Physician-citizens public roles and professional obligations. JAMA. 2004;291: 94-98.
9.
Bradley EH, Holmboe ES, Mattera J, et al. A qualitative study of increasing beta-blocker use after myocardial infarction: why do some hospitals succeed?JAMA. 2001;285:2604-2611.
10.
Mehta BH, Montoye CK, Gallogly M, et al. Improving quality of care for acute myocardial infarction: the Guidelines Applied in Practice (GAP) initiative. JAMA. 2002;287:1269-1276.
11.
Eagle KA, Garson AJ Jr, Beller GA, Sennett C. Closing the gap between science and practice: the need for professional leadership. Health Affairs. 2004;22:196-201.
12.
Locock L, Dopson S, Chambers D, Gabbay J. Understanding the role of opinion leaders in improving clinical effectiveness. Soc Sci Med. 2001;53:745-757.
13.
Thomson O'Brien MA, Oxman AD, Haynes RB, Davis DA, Freemantle N, Harvey EL. Local opinion leaders: effects on professional practice and health care outcomes. Cochrane Database Syst Rev.2000;(2):CD000125-CD000125.
14.
Bodenheimer T, Wang MC, Rundall TG, et al. What are the facilitators and barriers in physician organizations' use of care management processes?Jt Comm J Qual Safety. 2004;30:505-514.
15.
Hiss RG, MacDonald R, David WR. Identification of physician educational influentials in small community hospitals. Res Med Educ. 1978;17:283-288.
16.
Holmboe ES, Bradley EH, Mattera JA, Roumanis SA, Radford MJ, Krumholz HM. Characteristics of physician leaders working to improve the quality of care in acute myocardial infarction. Jt Comm J Qual Safety. 2003;29:289-296.
17.
Batalden PB, Nelson EC, Mohr JJ, et al. Microsystems in health care: Part 5. How leaders are leading. Jt Comm J Qual Safety. 2003;29:297-308.
18.
Baker DP, Salas E, King H, Battles J, Barach P. The role of teamwork in the professional education of physicians: current status and assessment recommendations. Jt Comm J Qual Patient Safety. 2005;31:185-202.
19.
Institute of Medicine. Educating Health Professionals: A Bridge to Quality. Washington, DC: National Academy Press; 2003.
20.
Shortell SM, Zazzali JL, Burns LR, et al. Implementing evidence-based medicine: the role of market pressures, compensation incentives, and culture in physician organization. Med Care. 2001;39:162-178.
21.
McGlynn EA, Brook RH. Keeping quality on the policy agenda. Health Affairs. 2001;20(3):82-89.
22.
Bodenheimer T, Wagner EH, Grumbach K. Improving primary care for patients with chronic illness. JAMA. 2002;288:1775-1779.
23.
McGlynn EA, Asch SM, Adams J, et al. The quality of health care delivered to adults in the United States. N Engl J Med. 2003;348:2635-2645.
24.
Baron RJ, Fabens EL, Schiffman M, Wolf E. Electronic health records: just around the corner? Or over the cliff?Ann Intern Med. 2005;143:222-226.
25.
Wolfson D, Leas B, Sofaer S, Pawlson LG, Pillittere D, Halim S. Quality improvement in small practice settings: motivations and barriers to measuring and improving primary care. Available at: http://www.abimfoundation.org/quality/pqip.shtm. Accessed June 26, 2006.
26.
Holmboe ES, Kim N, Cohen S, et al. Primary care physicians, office-based practice and the meaning of quality improvement: a qualitative study. Am J Med. 2005;118:917-922.
27.
Soumerai SB, McLaughlin TJ, Gurwitz JH, et al. Effect of local medical opinion leaders on quality of care for acute myocardial infarction: a randomized controlled trial. JAMA. 1998;279:1358-1363.
28.
Halvorson GC, Isham GJ. Epidemic of Care: A Call for Safer, Better, and More Accountable Heath Care. San Francisco: Jossey-Bass; 2003.
29.
Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academy Press; 2001.
30.
Enthoven AC, Tollen LA, eds. Toward a 21st Century Health System. San Francisco: Jossey-Bass; 2004.
31.
Aubert RE, Herman WH, Waters J, et al. Nurse case management to improve glycemic control in diabetic patients in a health maintenance organization: a randomized, controlled trial. Ann Intern Med. 1998;129:605-612.
32.
Jamtvedt G, Young JM, Kristoffersen DT, Thomson O'Brien MA, Oxman AD. Audit and feedback: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2003;(3):CD00259-CD00259.
33.
Shojania KG, McDonald KM, Wachter RM, Owens DK. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Vol. 1. Series Overview and Methodology. Technical Review 9. AHRQ Pub. No. 04-0051-2. Rockville, Md: Agency for Healthcare Research and Quality.
34.
Shojania KG, Ranji SR, Shaw LK, et al. Closing the Quality Gap: A Critical Analysis of Quality Improvement Strategies: Vol. 2. Diabetes. Technical Review 9. AHRQ Pub. No. 04-0051-2. Rockville, Md: Agency for Healthcare Research and Quality.
35.
American Board of Medical Specialties. Evaluating practice performance for MOC. Available at: http://www.abms.org/MOC.asp.
36.
American Board of Internal Medicine. Practice improvement module. Available at: https://www.abim.org/online/pim/DEFAULT.ASPX.
37.
American Academy of Pediatrics. Education in quality improvement for pediatric practice. Available at: http://www.eqipp.org/.
38.
American Academy of Family Practice. METRIC program. Available at: http://www.aafp.org/metric.xml.
39.
Spath PL. Using failure mode and effects analysis to improve patient safety. AORN J. 2003;78(1):16-37.
40.
American Medical Association. Physician consortium on performance improvement: mission and values. Available at: http://www.ama-assn.org/ama/pub/category/15335.html. Accessed June 26, 2006.
41.
American College of Cardiology. ACC-Cathkit. Available at: www.acc.org/quality/cathkit.
42.
American College of Physicians. A look at the college's effort to examine “best practices.” Available at: www.acponline.org/journals/news/may99/bestprac.htm.
43.
Weingart SN, Tess A, Driver J, Aronson MD, Sands K. Creating a quality improvement elective for medical house officers. J Gen Intern Med. 2004;19:861-867.
44.
Ogrinc G, Headrick LA, Mutha S, Coleman MT, O'Donnell JO, Miles PV. A framework for teaching medical students and residents about practice-based learning and improvement, synthesized from a literature review. Acad Med. 2003;78:748-756.
45.
Ogrinc G, Headrick LA, Morrison LJ, Foster T. Teaching and assessing resident competence in practice-based learning and improvement. J Gen Intern Med. 2004;19:496-500.
46.
Djuricich AM, Ciccarelli M, Swigonski NL. A continuous quality improvement curriculum for residents: addressing core competency, improving systems. Acad Med. 2004;79:S65-S67.
47.
Holmboe ES, Prince L, Green ML. Teaching and improving quality of care in a residency clinic. Acad Med. 2005;80:571-577.
48.
D'Amour D, Oandasan I. Interprofessionality as a field of interprofessional practice and interprofessional education: an emerging concept. J Interprofessional Care. 2005;1:8-20.
49.
Landon BE, Normand SL, Blumenthal D, Daley J. Physician clinical performance assessment: prospects and barriers. JAMA. 2003;290:1183-1189.
