A university system's approach to enhancing the educational mission of health science schools and institutions: the University of Texas Academy of Health Science Education.

BACKGROUND: The academy movement developed in the United States as an important approach to enhance the educational mission and facilitate the recognition and work of educators at medical schools and health science institutions. OBJECTIVES: Academies initially formed at individual medical schools. Educators and leaders in The University of Texas System (the UT System, UTS) recognized the academy movement as a means both to address special challenges and pursue opportunities for advancing the educational mission of academic health sciences institutions. METHODS: The UTS academy process was started by the appointment of a Chancellor's Health Fellow for Education in 2004. Subsequently, the University of Texas Academy of Health Science Education (UTAHSE) was formed by bringing together esteemed faculty educators from the six UTS health science institutions. RESULTS: Currently, the UTAHSE has 132 voting members who were selected through a rigorous, system-wide peer review and who represent multiple professional backgrounds and all six campuses. With support from the UTS, the UTAHSE has developed and sustained an annual Innovations in Health Science Education conference, a small grants program and an Innovations in Health Science Education Award, among other UTS health science educational activities. The UTAHSE represents one university system's innovative approach to enhancing its educational mission through multi- and interdisciplinary as well as inter-institutional collaboration. CONCLUSIONS: The UTAHSE is presented as a model for the development of other consortia-type academies that could involve several components of a university system or coalitions of several institutions.

Ensuring quality cancer care: a follow-up review of the Institute of Medicine's 10 recommendations for improving the quality of cancer care in America.

Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US health care system in the late 1990s. The National Cancer Policy Board (NCPB), a 20-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system in which patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. The report outlined 10 recommendations, which, when implemented, would: 1) improve the quality of cancer care, 2) increase the current understanding of quality cancer care, and 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating health care costs, has prompted national efforts to reform the health care system. These efforts by health care providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States.

Health care quality and how to achieve it.

Studies conducted by the Institute of Medicine have demonstrated a serious gap between what the American health care system provides and its full potential. This results from a substantial amount of overuse, underuse, and misuse of health care. An Institute of Medicine (IOM) publication focusing attention on medical errors--To Err is Human: Building a Safer Healthcare System--galvanized the public and private sector as well as the professions to strive for building a safer health care system. In its report, Crossing the Quality Chasm: A New Health System for the 21st Century, the IOM's committee visualized a series of aims and rules for the health care system that would propel it successfully into the 21st century. Multidisciplinary professional teams should provide care for an increasing portion of the population (now about 40%) who have one or more chronic illnesses. Since 20 conditions account for 80% of America's health care costs, the author recommends that a special focus be placed upon 15 of these conditions to systematically improve the quality of care over the next five years. Information technology offers important opportunities to improve patient safety and contribute to better and continuous improvement of quality. The elimination of written clinical notes by the year 2010 is an achievable objective. These developments require medical educators and health professionals to move from a 20th-century paradigm of the physician who was in solo practice, held autonomy as a central value, prided himself or herself upon continuous learning and the acquisition of new knowledge, and laid claim to infallibility when confronting patients and colleagues. The 21st-century paradigm is that of physicians who understand teamwork and systems of care in which they can provide leadership. Group practice, both virtual and real, will allow the support of information systems, the collection of evidence about care, and efforts for continuous quality improvement. Fallibility should be replaced by an approach to multidisciplinary problem solving, and the acquisition of knowledge must be associated with the commitment and understanding of the need for change.