Department of Medicine

Quality Improvement: What's Next?

As the newly-appointed Vice Chair for Clinical Quality Implementation, Ann Weinacker, MD, Professor of Pulmonary and Critical Care, has a unique opportunity to make improvements in how clinical care is delivered at Stanford. This year her energy will be devoted to increasing patient satisfaction, reducing medical errors, and standardizing care
Ann Weinacker MD Vice Chair Quality Implementation
Ann Weinacker, MD, Vice Chair
where it is appropriate. Gathering input from leadership, the Divisions, and other stakeholders will be a key element in how she goes about the task. In this Q and A article, Weinacker shares her thoughts about her new position with Medicine Rounds.

Medicine Rounds: How do you see your role over the next few years?

Ann Weinacker: We need to rethink the way we deliver care and recognize how important the people we are taking care of are. We are all busy doing our research, our administrative work, our teaching, whatever it happens to be, and patients sometimes seem like an afterthought in the way that we do our work. We need to be thinking of ways that we can accommodate their schedules as well as our own. That doesn’t mean that we have to be selfless and can’t pay attention to our own families, our lives, and our other work. But there are ways that we can approach these things that will provide the experience that our patients need, and the respect that they deserve, while also respecting our own time, our families, and our lives.

What I also hope to be doing over the next couple of years is to help shift the culture so we pay more attention to guidelines, and to standardization of care where it can be standardized, so that we don’t have to think so hard about very routine things and can devote more energy to thinking about how to treat the patients who don’t really quite fit into that “routine” category.

We have a medicine quality council, and I think we can make it more robust. I would like to get people more involved in the work that the medicine quality council does. We need to improve access to care, patient satisfaction, adherence to guidelines.

We need to think about better ways to document the care that we give and be certain that we document enough about what co-morbid conditions currently exist in our patients so that the expected mortality calculation is more realistic.

MR: How will you introduce these changes?

AW: This will be a collaborative effort.  I don’t pretend to know all the solutions to our challenges.  I need the faculty to educate me in a lot of ways. What do we know we should be doing in pulmonary, for example in asthma? In rheumatology, for rheumatoid arthritis, lupus, and other conditions? In cardiology a lot of information has been published, but there are a lot of guidelines and best practices that I don’t know about. So I think this is going to be a give-and-take process.
We all need to work together to come up with the right answers to the questions. And some of the questions we don’t even know yet. I suspect we are going to determine what some of the questions are as we go.

MR: How will you measure improvement?

AW: In areas where there are guidelines, we can look to see the percentage of compliance with those guidelines. In primary care, for example, there are more guidelines and more quality measures that have been established than in any of the subspecialties. We can look at things like diabetes care, how often the hemoglobin A1C and other things are measured, what kind of instruction patients are getting regarding foot care. There are a lot of things that you might not always think about that are best practices in the management of various diseases. So one thing is how often we are adhering to established guidelines. In some areas we might need to develop our own metrics and guidelines and then see how well we can be in compliance with those.

As far as the patient satisfaction piece is concerned, one thing we can do is look at Press Ganey scores. But Press Ganey is not perfect; we may at some point want to look at something more individualized for our clinics and in the inpatient arena, which has been harder to evaluate on an individual physician level.

MR: How will you collaborate with Paul Heidenreich, Vice Chair of Clinical Quality-Analytics?

AW: Paul and I are still working out those details. Paul knows a lot about the types of metrics and the kinds of quality initiatives that we need to be implementing in various Divisions. He can help us determine if we are really doing what we think we are doing and can help us to better measure various aspects of our care and publicize what we are doing. Paul wants to be part of the implementation process as well. So I think we will be working together, playing off each other’s strengths and learning from each other about how to do this. Paul is going to bring an awful lot to this that I couldn’t begin to bring, so I am looking forward to what we can do in the Department together.

MR: Do you feel like you will be the quality police? How will you put a positive spin on this?

I don’t want to be the quality police; I would like to be the quality conductor, like the conductor of an orchestra of extremely talented musicians. The Department is full of extremely talented physicians and we all honestly want to do a good job, so I’d like to help organize us into a cohesive group that works well together to deliver the best care possible.  It’s about how we balance doing a good job, having a personal life, and always giving patients what they need. And we need to be certain that we take care of ourselves well enough to be able to take care of our patients.


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