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Part II: ISO clinician leaders in patient safety and quality

studentsI recently gave a talk to the American Medical Student Association. The energy in the room was palpable. The students were excited, passionate and hopeful. We spoke about the urgent need to reduce preventable harm and to enhance value, and we discussed that they will need to be the ones to lead these efforts.

Yet, in speaking with them, I had to confront the sad reality that most of them will graduate ill-prepared to lead the improvements of quality and safety our health care system needs. They no doubt will know chemistry, biology and physiology, but they may not know about human factors, implementation science or performance measurement—the language of quality improvement. They will know orthopedics and genetics but they won't know teamwork and systems engineering. They likely know about German scientist Rudolph Virchow, the father of cell theory, yet they do not know John Kotter, the father of change theory whose model for leading change is highly effective and widely used. Without a doubt, these students will need to lead change.

If we are going to make progress in safety, we have to ensure we train a workforce to head up these efforts. Health care is moving in this direction. Many medical schools now teach patient safety, though on average just four hours is devoted to the subject, and residencies require training in systems-based practice. While this is encouraging, it is unlikely that these efforts go deep enough to ensure that clinicians can lead the needed changes in our health care system. Just as science guides training in basic science and clinical medicine, science also needs to guide training in health delivery science. As part of the Armstrong Institute at Johns Hopkins Medicine, we're developing a training program for working clinicians and clinical leaders that has a hierarchy of skills and competencies.

Our goal is to ensure that all clinicians have a basic understanding of the science of patient safety, provide patient- and family-centered care, practice teamwork and deliver clinical excellence. Unit-level safety leaders require greater skills—such as understanding how to identify and learn from mistakes, implementing programs that are proven to reduce harm, and using performance improvement methods, including Lean Sigma. Departmental and hospital leaders need the skills of unit-level leaders, yet they also need skills to design, implement and evaluate interventions. These measurement skills are essential if we are to know whether patient outcomes are actually improving. The safety leaders also need skills in human factors and systems engineering and leading change.

We do not know of a health care organization that has this type of robust infrastructure for improving quality and safety. If health care is to reduce harm, it will need to develop a skilled workforce, with time devoted to improving safety and with clear responsibilities for doing so. The Armstrong Institute, in conjunction with the Johns Hopkins Bloomberg School of Public Health, is developing such a training program for clinicians, for unit leaders, and for department and hospital leaders. These training programs will also be available to people outside of Hopkins.

We have learned over the last decade that quick fixes won't improve patient safety. Just as in every other area of medicine, science must guide the way. This is a new science, a science that most medical schools and nursing schools still do not teach. We need to take the enthusiasm we see in our future doctors and nurses and channel that energy into producing a workforce that is not only trained to improve safety, but truly embraces the goal of finding the best ways to prevent patient harm, optimize clinical and patient-reported outcomes, and enhance value.


Peter Pronovost

One of the world’s leading authorities on patient safety, Peter Pronovost served a the director of the Armstrong Institute, as well as senior vice president for patient safety and quality, at Johns Hopkins Medicine from 2011 until January 2018.

9 thoughts on “Part II: ISO clinician leaders in patient safety and quality”

  1. Hello
    I am sudanese ,i have just finished my internship period
    It's very kind of you to talk about patient safety & Quality
    I am very interesting in your training program
    is there chance for me as foriegner ! To enjoy with your training program information
    Kind regards

    1. It's great to hear about your interest in patient safety. The program we're developing with the School of Public Health will be open to anyone.

  2. Hi, I read your article on safety and I do agree that we now have to set up a program to guide those who will follow with a patient safety program. Can you explain to me the foundation of your safety committee? What is the daily agenda for patient safety? Thanks

  3. Thank you for sharing your vision for future medical education. Recently, I had a chance to talk few friend's high school kids. They want to study medicine and than want choose biology as pre-med for colleague. When I suggest them to learn more about engineering (systems thinking), IT (technology driven innovation), management ,etc. beyond biology. It seems foreign to them. Apperently their teacher didn't catch up what is happening in the frontier of medicine (like Armstrong institue). Maybe the patient safety education need to extent to high school? There is a long way to go to create critical mass (of providers) to understand the limitation of "craftsmanship" medicine and willing to embrase a new kind of hero. ( Let us work together to move this forward. Thank you ! Yue

  4. Pingback: Health Care Needs a New Kind of Hero to improve #ptsafety « Sim Doc’s Weblog

  5. Many thanks for your investment in this incredible training resource. When might it be available to students & residents outside Hopkins? Will there be a tuition fee? Do you have any recommendations as to the best current, free source for a resident-level training curriculum? The NPSF offers what looks like a great web-based curriculum but I argue that most residents can't afford to pay additional tuition for this training.

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