A house officer-sponsored quality improvement initiative: leadership lessons and liabilities.
BACKGROUND
House officers play an important role in the care of hospitalized patients, yet they are infrequent participants in quality improvement (QI) activities. A grassroots QI initiative among medical house officers was implemented at Beth Israel Deaconess Medical Center's East Campus in Boston from 1995 through 1997.


RESULTS
A group of house officer volunteers completed five of nine projects, including a survey that demonstrated frequent failures of cardiac monitor-defibrillators in the emergency room. Reaching out to key administrators produced several quick fixes. Developing effective, ongoing partnerships with clinical departments and QI professionals proved more problematic.


CONCLUSIONS
Residency training programs that provide experience in QI give house officers a potentially valuable skill and an additional means to improve the quality of patient care. Yet many obstacles work against house officers' participation in QI initiatives, including long hours and the daily demands of patient care, rotating monthly assignments, and clinical leaders' assumption that they have little interest in QI. The organizers of the officer problem-solving group over-estimated the hospital resources at their disposal and failed to build mechanisms to ensure the initiative's continuation into its second year, when their own interest waned and no new group of leaders emerged to take their place.


CONCLUSIONS
House officers represent an underused resource for QI. They are skilled at identifying problems but have difficulty executing sustained and complex QI initiatives. Peer leadership is a potent means to mobilize resident-physician participation but may require faculty or staff involvement and support to guarantee its continuity.
Weingart
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Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA. saul_weingart@bidmc.harvard.edu
D001900:Boston; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching / Q000592:standards*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration* / Q000592:standards; D007857:Leadership; D008332:Management Quality Circles; D009936:Organizational Innovation; D010819:Physician's Role; D011340:Problem Solving; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*