Can Low-Performing Hospitals Train High-Performing Residents?

Abstract

Training residents to be high-performing physicians is key to transforming the US health care system. Current policies to improve the performance of health care practitioners and the institutions in which they practice depend primarily on financial incentives aimed at changing the behavior of fully trained professionals. But there is no guarantee that the effects of these financial incentives "trickle down" to influence residents. A 2009 study 1 comparing residents' knowledge of quality and safety in higher versus lower performing major teaching hospitals found that those hospitals' quality and safety improvement mechanisms were detached from the educational enterprise. That makes these financial incentives much less effective than intervening directly in the workforce "pipeline" to influence residents during their training and professional socialization.The 2010 Medicare Payment Advisory Commission (MedPAC) Report to the Congress: Aligning Incentives in Medicare cited research that internal medicine residency programs had limited focus on skills such as quality measurement and improvement, evidence-based medicine, multidisciplinary teamwork, care coordination across settings, and health information technology. These skills are important for producing the health professionals we need for a high-performance delivery systemone that provides high quality, high value, and efficiently delivered services. 2(p103) To improve medical care, it will be necessary to change the culture of programs that prepare professionals who will organize, manage, and practice in future high-performing health care organizations.Medicare funding for graduate medical education (GME) in 2009 totaled $9.5 billion. MedPAC's 2010 report recommended that the Secretary of Health and Human Services "develop a GME payment system that fosters greater accountability for Medicare's GME dollars and rewards education and training that will improve the value of our health care delivery system." 2(p105) In addition to Medicare support for GME, 41 states and the District of Columbia made Medicaid GME payments totaling $3.78 billion in 2009. With state governments under enormous financial pressure, a "value

Practice Variation, Bias, and Experiential Learning in Cesarean Delivery: A Data‐Based System Dynamics Approach

“…One implication from the strong effect of early‐career experiences is that intervening during residency programs may have lasting effects, which is consistent with other work emphasizing the importance of residency training (Asch et al. ; Legnini ). However, our finding that CD rates increase with physicians' years of experience suggests that one‐time interventions may not be as effective as repeated interventions.…”