As chief medical officer for Geisinger Health Plan, John Bulger, DO, MBA, is intimately acquainted with the daily challenges that intersect with the delivery of safe, quality-driven care in the hospital system.
He’s also very familiar with the intricacies of carving out a professional roadmap. When Dr. Bulger began practicing as an internist at Geisinger Health System in the late 1990s, there wasn’t a formal hospitalist designation. He created one and became director of the hospital medicine program.
The early days: QI training
Years later, when the opportunity arose to become chief quality officer, Dr. Bulger was a natural fit for the position, having led many improvement-centered committees and projects while running the hospital medicine group.
But the quality know-how did not come without additional training.
“While competencies like problem-solving and being a good listener and team player are part of the job of being a hospitalist, they don’t make you an expert in QI,” Dr. Bulger says. “There are learned skills that you need to spend time developing.”
Early in his QI immersion, Dr. Bulger sought training where available from sources such as the American College of Physicians and SHM, while familiarizing himself with methodologies such as the Plan-Do-Study-Act method and Lean. There are far more QI training opportunities available to hospitalists today than when Dr. Bulger began his journey, but the fundamentals of success come back to finding the right mentors, team building, and implementing projects built around SMART (specific, measurable, achievable, results-focused and timebound) goals.
How to get started with QI
To get started, Dr. Bulger suggests to “pick something within your scope, like medical reconciliation for every patient, or ensuring that every patient who leaves the hospital gets an appointment with their primary physician within seven days. Early on, we were working on issues like pneumonia core measures and providing discharge instructions.”
He cautions those starting out in QI against viewing unintended outcomes or project setbacks as failure. “If your goal is to take a (scenario) from bad to perfect, you’ll end up getting discouraged. Any effort toward making things better is helpful. If it doesn’t work, you try something else.”
While Dr. Bulger is fully supportive of the impact that quality improvement projects make at the institutional level, he encourages clinicians and researchers to always keep the Institute for Healthcare Improvement’s Triple Aim in sight, which calls for:
- Improving the patient experience of care (including quality and satisfaction);
- Improving the health of populations; and
- Reducing the per capita cost of health care.
“We need better measures and more discussion about what is best for patients,” Dr. Bulger says. “The things we talk about in (health care)—readmission rates, glycemic control—have a minimal impact on people’s health, but the social determinants of health—the patient’s housing and economic situation—play a bigger role than anything else. As we move from provider- to patient-centric communities by fixing the Triple Aim, the experience will be better for both providers and patients.”