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IMPROVING PATIENT CARE

Improving Patient Care is a special section within Annals supported in part by the U.S. Department of Health and Human Services (HHS) Agency for Healthcare Research and Quality (AHRQ). The opinions expressed in this article are those of the authors and do not represent the position or endorsement of AHRQ or HHS.

Problem Doctors: Is There a System-Level Solution?

Lucian L. Leape, MD, and John A. Fromson, MD

17 January 2006 | Volume 144 Issue 2 | Pages 107-115

Physician performance failures are not rare and pose substantial threats to patient welfare and safety. Few hospitals respond to such failures promptly or effectively. Failure to ensure the quality and safety of the performance of colleagues is a breach of medicine's fiduciary responsibility to the public. A major reason for this deficiency is the hospitals' lack of formal systems to monitor physician performance and to identify and correct shortcomings. To develop and implement these systems, hospitals need better performance measures and substantial expansion of external programs for assessment and remediation. This is a task well beyond the capacities of individual hospitals; a national effort is required. The authors call on the Federation of State Medical Boards, the American Board of Medical Specialties, and the Joint Commission on Accreditation of Healthcare Organizations (organizations that already bear a fiduciary responsibility for ensuring safe, competent care) to collaborate on developing better methods for measuring performance and to expand programs for helping practitioners who are deficient.

Author and Article Information

From the Harvard School of Public Health and Harvard Medical School, Boston, Massachusetts.

Potential Financial Conflicts of Interest: Grants received: L.L. Leape (Robert Wood Johnson Foundation).

Corresponding Author: Lucian L. Leape, MD, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02215; e-mail, leape{at}hsph.harvard.edu.

Current Author Addresses: Dr. Leape: Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02215.

Dr. Fromson: MetroWest Medical Center, 67 Union Street, Natick, MA 01760-6099.

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