Five Tactics to Quickly Build Quality Improvement and Patient Safety Capacity at Academic Health Centers

In this issue, Coleman and colleagues propose an ambitious strategic action framework for academic health center (AHC) department chairs seeking to expand faculty expertise in quality improvement and patient safety (QI/PS). Noting the advent of value-based payment models and that AHCs lag behind some community hospitals in QI/PS, Coleman and colleagues call for deliberate, proactive faculty development and recognition measures to build QI/PS capacity at AHCs. In this Invited Commentary, the author addresses the five challenges to strengthening QI/PS capacity identified by Coleman and colleagues: (1) the mentorship gap: the paucity of expert senior faculty who can mentor junior colleagues in QI/PS; (2) data and analytic bottlenecks: information systems and analytic requests to support QI/PS projects often get pushed to the back of long queues of prioritized queries from other departments, effectively halting QI/PS projects; (3) misalignment between existing reimbursement mechanisms and QI/PS: current fee-for-service and prospective payment mechanisms drive high utilization of costly interventions and can financially penalize organizations that keep patients well and avoid interventions; (4) limited recognition for QI/PS achievement in academic advancement decisions; and (5) pressure to invent and deploy alternative business models that reward value and results rather than the volume and pricing of services, to better align payer, provider, and patient incentives around high-value care. The author outlines practical short-term measures to mitigate the first four challenges and a more expansive vision for AHCs to transform their business models and regain a leadership position in QI/PS to address the fifth challenge.