Pronovost Peter J, Miller Marlene R, Wachter Robert M, Meyer Gregg S
Department of Anesthesiology and Critical Care Medicine, Quality and Safety Research Group, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA.
Acad Med. 2009 Dec;84(12):1651-6. doi: 10.1097/ACM.0b013e3181bce0ee.
While advances in biomedicine are awesome, progress in patient safety and quality of care has proven slow and arduous. One factor contributing to the labored progress is the paucity of physician-leaders who can help advance the science and practice of quality and safety. This limited talent pool, which has particularly serious consequences in academic medical centers (AMCs), stems from insufficient training in quality and safety, which in turn owes to our collective failure to view the delivery of health care as a science. Even when AMCs have trained and skilled quality and safety leaders, the infrastructure to support their work is deficient, with poorly defined job descriptions, competing responsibilities, and limited formal roles in the medical school compared with the hospital. Though there is limited empiric evidence to guide recommendations, the authors support four initiatives to accelerate national progress on quality and safety: (1) invest in quality and safety science, (2) revise quality and safety governance in AMCs, and (3) integrate roles within the hospital and medical school. Many of these shortcomings can be addressed by creating a newly integrated role: the vice dean for quality and hospital director of quality and safety. For AMCs to achieve significant improvements in quality and safety, they must invest in physician-leaders and in the support these leaders need to carry out their educational and operational roles.
尽管生物医学取得了令人瞩目的进展，但患者安全和医疗质量方面的进展却被证明是缓慢而艰巨的。导致进展艰难的一个因素是缺乏能够推动质量与安全科学及实践发展的医师领导者。这个人才库有限，在学术医疗中心（AMC）产生了尤为严重的后果，其根源在于质量与安全方面的培训不足，而这又归因于我们未能将医疗服务视为一门科学。即便AMC培养了有技能的质量与安全领导者，支持他们工作的基础设施也存在缺陷，包括工作职责定义不明确、职责相互冲突，以及与医院相比，医学院的正式角色有限。尽管指导建议的实证证据有限，但作者支持四项举措以加速全国在质量与安全方面的进展：（1）投资质量与安全科学；（2）修订AMC的质量与安全管理；（3）整合医院和医学院内部的角色。通过创建一个新的整合角色——质量副院长兼质量与安全医院主任，可以解决许多此类缺陷。AMC要在质量与安全方面取得显著改善，就必须投资于医师领导者以及这些领导者履行教育和运营职责所需的支持。
