Blog | Thursday, June 4, 2015

The new health care epidemiologist


The April issue of Infection Control and Hospital Epidemiology has a white paper on skills and competencies for the health care epidemiologist. True to form, the paper reflects the rather timid approach that the Society for Healthcare Epidemiology of America (SHEA) never seems able to shake. As a disclaimer, I should state that I sit on the Board of Trustees of SHEA, and I'm not saying anything in this post that I haven't shared previously.

While the paper mentions that the health care epidemiologist should have an understanding of quality improvement and safety, and is a valuable partner to the Chief Quality Officer (CQO), what it should state is that the health care epidemiologist is uniquely qualified to be the CQO. Infection prevention was the first quality improvement (QI) program ever to emerge and remains better developed than QI and patient safety. Many health care epidemiologists have advanced degrees in public health or epidemiology, and the skill set is directly transferable to QI and safety.

Increasingly hospitals are developing CQO positions, but very few of these positions are held by health care epidemiologists. In some cases, CQOs may not have a true appreciation for the value of the health care epidemiologist, and some of us fear that healthcare epidemiologists as we know them may ultimately be replaced by less trained individuals. Interestingly, Dick Wenzel published a book on quality improvement in 1992, but unfortunately, SHEA chose to remain confined to infectious adverse outcomes rather than expanding into the quality realm.

So my recommendations are these:
1. SHEA should move aggressively and quickly into the quality and safety space.
2. To broaden the skillset of the healthcare epidemiologist, SHEA needs to sponsor education on leadership, implementation science, human factors engineering, Six Sigma, Lean, and other quality improvement and patient safety topics.
3. As much as I hate to talk about certification given the absolute mess the American Board of Internal Medicine has made of our certification processes, I continue to believe that health care epidemiology will never be seen as a valid entity until there is certification. Once certification occurs, then it becomes possible to build the requirement for a health care epidemiologist into payer's conditions of participation, hospital accreditation, and hospital quality rankings. We need to make the health care epidemiologist indispensable.
4. SHEA's journal, Infection Control and Hospital Epidemiology, should specifically solicit papers focused on noninfectious adverse outcomes, quality improvement and patient safety.

In a nutshell, SHEA should define the role of the health care epidemiologist more broadly, which in the long run will help its members more easily achieve leadership positions in hospitals and have a seat at the table when important decisions are made.

Michael B. Edmond, MD, FACP, is the Chief Quality Officer at the University of Iowa Hospitals and Clinics. This post originally appeared at the blog Controversies in Hospital Infection Prevention.