Quality improvement is something that UMASS Memorial Medical Center (UMMMC) has been focusing on since 2007 when Robert A. Klugman, MD came on board as senior vice president, chief quality officer, and medical director of managed care. One of his main focuses was changing the existing role of physician quality officers (PQO) from the traditional role to a new and improved role.
At the time, the traditional PQO was responsible for a clinical department and there was a tremendous variation in the amount of work each one was putting into improving the healthcare system. This variation was one of the main reasons why Klugman wanted to change the existing structure.
"A key component is engaging clinicians in this type of quality improvement effort, and getting them on board with quality improvement work," says Klugman.
Klugman decided to focus on a multi-disciplinary role for PQOs in the quality department. The PQOs would focus on systems improvement and be centralized within one multi-disciplinary office rather than focus on their separate clinical departments.
Even now, two years after Klugman instituted the new PQO model, physicians, other facilities, and national organizations continue to show interest in this model.
"Our model has been very successful," says Klugman. "The PQOs are now highly regarded by their colleagues which has fostered increased engagement by the medical staff in quality improvement initiatives. This is a big challenge in every organization."
Traditional vs. new
Many facilities have the traditional model in place, where the chief medical officer handles medical staff issues, credentialing, and privileges and the chief quality officer dedicated to handling quality improvement issues. Both the chief medical officer and the chief quality officer report to the chief executive officer. It quickly became apparent to Klugman that this structure wasn’t working at UMMMC.
"The lone ranger can't really do the work, particularly in larger organizations, without the engagement of the medical staff," says Klugman.
Continuing with the traditional model, each clinical department is responsible for quality improvement work in its own department. The department chair appoints a person in charge of quality improvement, who may not have had formal training and works only in his or her own department. Quality improvement work is not coordinated or organized between departments.
Klugman saw two major problems with this model:
Klugman wanted to ensure that UMMMC's quality improvement work continued to evolve along side healthcare as it becomes more patient centered.
"There is really a major push to take care from the bedside, and the patient perspective, and disease perspective, rather than divide it up into which department best fits," says Klugman.
Klugman's model was devised to recruit physicians who wanted to work as a PQO and was not based on departmental assignment.
"The PQO would work for the department of quality, but not necessarily in the department related to their medical discipline," says Klugman.
PQO for hire, training, and work
Klugman and a selection committee made up of department chairs, nursing leaders, quality improvement experts, the chief quality officer, and the medical center president helped sort through the 25 in-house applicants for the PQO positions.
The PQOs were and are currently required to:
From the 25 original applicants, seven were chosen. They came from surgery, internal medicine, pediatrics, pediatric emergency medicine, obstetrics and gynecology, family practice, and cardiology.