title: Initiating the firm system at a community teaching hospital.
abstract: The Medical Center of Central Massachusetts-Memorial, a 350-bed private community teaching hospital, initiated a firm system for multiple reasons: to improve teaching, improve physician nursing relations, improve discharge planning, and to improve quality assurance/utilization review activities. In this system, private physician groups were randomized to four geographic medical wards, each of which had a distinctive subspecialty identity: oncology, cardiology, nephrology, and diabetes. Primary care internists became the Firm Directors, and subspecialists, already identified with those geographic wards, became Associate Firm Directors. The new system has produced several exciting successes; better bedside teaching and a project to shorten the length of stay of common diagnoses are two examples. Problems remain: resident complaints about imbalanced admissions and an increased census are two issues that we must overcome.
authors.affiliation: Medical Center of Central Massachusetts, Worchester 01605-2982.
authors.forename: T H
authors.initials: TH
authors.lastname: Ebert
mesh_terms: D006302:Health Services Research; D006745:Hospital Bed Capacity, 300 to 499; D006764:Hospitals, Community / Q000458:organization & administration*; D006784:Hospitals, Teaching / Q000458:organization & administration*; D006801:Humans; D007902:Length of Stay; D008404:Massachusetts; D008511:Medicine / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration; D011897:Random Allocation; D013038:Specialization