Quality in Pediatrics: A Progress Report for the American Academy of Pediatrics

In the fall of 1999, quality of care was raised to a new level of prominence at the American Academy of Pediatrics (AAP). At that time, Donald M. Berwick, Chief Executive Officer of the Institute for Healthcare Improvement, posed a challenge to the AAP in his keynote address at the AAP’s annual meeting. Steve Berman, then newly elected as AAP President, made quality one of the key initiatives in his presidency.1 How far has the Academy come since that time, and where does it need to go if this renewed focus is to make a difference for the children we serve? Berwick challenged the Academy to build the credibility of our profession and of organized medicine by making a strong and visible commitment to enhancing the quality of care that our patients—children and their families—receive. Building on theories on leadership of change,2 he recommended the Academy take 5 steps: 1. Make a commitment to a bold aim, such as reducing inappropriate antibiotic use. 2. Choose public measures to track our progress. 3. Find the best ideas and generate a campaign. 4. Take action—learning from our successes and failures. 5. Collaborate with others—family physicians, nurses, and pharmacists. When Berwick issued this challenge, few of us knew how other events would shape the environment in which the Academy would be responding to this challenge. In December 1999, the issue of patient safety broke onto public consciousness.3 Patient safety not only provoked public attention, but also political and policy reaction. Although some thought the issue might pass, it appears to have staying power and pediatrics is not immune. Indeed, the “poster child” case at national hearings hosted by the Agency for Healthcare Research and Quality was a 5-year-old with kernicterus.4 Changes have also taken place in requirements for both residency education and board certification … Address correspondence to Charles J. Homer, MD, MPH, National Initiative for Children’s Healthcare Quality, 375 Longwood Ave, Fourth Floor, Boston, MA 02215. E-mail: [chomer@ihi.org][1] [1]: http://chomerihi.org