Quality improvement and patient safety activities in academic departments of medicine.

Academic departments of internal medicine have traditionally focused on their mission to provide clinical services, educate the next generation, and conduct research. As requirements to engage in formal quality improvement and patient safety (QI/PS) activities increase, academic departments provide an important setting to design, implement, and critically evaluate care delivery systems, as well as lead the science and application of QI/PS efforts nationally. Academic departments traditionally have played a passive role in QI/PS activities, which were predominantly carried out by the hospital. More often than not, governance structures for the medical school and the hospital are separated, with distinct cultures, finances, and reward systems. Quality and safety leaders often reside organizationally within the hospital’s quality departments, with little connection to the medical school or graduate medical education. This organizational dichotomy makes it challenging to engage department chairs, clinicians, and educators in QI/PS efforts. As the role of academic department in QI/PS activities evolves, the organizational structure around these activities (eg, where QI/PS leaders reside, who owns these activities, how they are funded and supported) will change. Currently, little information is available on the organizational structure of QI/PS activities within academic departments. It is unclear the types of QI/PS activities in which departments are involved and how much ownership they assume. A recent review of the literature revealed only 2 articles that provide a comprehensive overview of how QI/PS activities are organized within a single academic department. To learn about the current organizational structure of QI/PS activities in academic departments in US medical schools, we surveyed chairs and QI/PS managers about the scope and content of QI/PS activities in their departments. The goal of this article is to describe the current state of involvement and ownership for QI/PS activities in academic departments, including how these activities are supported and funded.