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Background: Master clinicians are recognized as multidimensional experts in clinical medicine. Studying their formative clinical activities could generate insights to guide medical trainees and early career clinicians. Objectives: To investigate which early career activities were adopted more commonly by master clinicians than their matched peers and to characterize master clinicians' early career activities across institutions and specialties. Subjects and Methods: We surveyed master clinicians at seven medical centres about their early career activities. For master clinicians in the Department of Medicine (DOM), we also surveyed matched internist peers. Results: Of 150 master clinician respondents, 65% were internists (DOM); 35% practiced in other specialties. Compared to their internist peers, there was a trend toward internist master clinicians reading more about their patients' conditions (6.0 vs. 4.8 h per week), reading more case reports (4.0 vs. 2.1 per month), engaging in more frequent teaching duties and devoting less time to research. Conclusions: The early career activities identified in this study can be adopted by clinicians pursuing clinical excellence and promoted by training programs that seek to foster life‐long learning. [ABSTRACT FROM AUTHOR]

Objectives: Changes in the US healthcare economic system are requiring academic health centers (AHCs) to restructure in pursuit of their traditional tripartite missions; engaging the individuals focused on clinical care is becoming more important. We conducted this study to guide our institution's transformation by identifying ways to formally recognize clinicians who are excelling in patient care and understand which forms of acknowledgment would be acceptable and motivating.Methods: A survey was developed by a large committee with representation spanning the AHC and was sent electronically in spring 2014 to stakeholders across the institution. Items assessed perceptions of the importance and present state of valuing clinical excellence, the utility of 14 potential metrics to assess clinical excellence, and the meaningfulness of seven potential rewards for clinical excellence. Bivariate and multivariate logistic regression models analyzed differences (P < 0.05) by respondent sex, ethnicity, academic rank, primary clinical affiliation, and time spent in patient care and research activities.Results: A total of 1716 of 3168 (54%) stakeholders responded, including 1198 of 2151 (56%) individuals from academic hospitals, 114 of 276 (41%) from the outpatient affiliated practices, and 304 of 741 (54%) from satellite locations. Nearly everyone (96%) agreed that clinical accomplishments should be recognized, although a minority (47%) believed that clinicians were already valued. Most respondents selected 7 or more of 14 metrics as valid and reasonable for assessing clinical excellence. Popular metrics (eg, clinical productivity) were not believed to represent clinical excellence as much as others (eg, professionalism). Multivariate analysis found the least agreement among stakeholders on using published scholarship as evidence for clinical excellence, with the widest differences comparing senior faculty versus nonfaculty (88% vs 27%) and those with >75% of their time spent in patient care versus others (37% vs 73%). Most (six of seven) types of reward were perceived as meaningful by the majority of respondents, with little variation among subgroups across bivariate and multivariate analyses.Conclusions: This system-wide assessment was successful at identifying new strategies for recognizing clinical excellence. Other AHCs seeking institutional transformation may wish to perform a similar assessment. [ABSTRACT FROM AUTHOR]

Experts in the field of palliative care in the United States (U.S.) have defined competence, or "good," mainly for programs, trainees, or providers of primary palliative care. Our interprofessional workgroup of palliative care specialists proposes that setting a standard for clinical excellence, or "great," applicable to palliative care specialists of all professions will elevate the field in the U.S. by providing an aspirational target usable for individual assessment and self-assessment, highlighting the common ground between team roles, and promoting a deeper understanding of teamwork, utilization, and productivity. We call for research that utilizes inclusive methods and broad representation of diverse voices to design a vivid, practical, and evidence-based definition of clinical excellence for palliative care specialists.

The author emphasizes the need to focus on quality in mental health and addictions treatment. High-quality care means care that is personalized, prevention-oriented, and based on evidence about the benefits, costs, and the desires of each person. Whereas the challenges to improving quality are formidable, four critical issues can and must be addressed: focus on whole health, clinical excellence, workforce, and information technology. With strong leadership, commitment, and persistence, we can have a system that supports recovery and ensures a meaningful life in the community for our sickest and poorest citizens. [ABSTRACT FROM AUTHOR]

The already frayed mental health and addictions safety net is in danger of collapse as demand for behavioral health services reaches an all-time high. The backdrop to our field’s everyday struggles is health care reform. The details and implications of health care reform for the mental health and addictions community remain uncertain. What is certain is that we must build upon our 2008 legislative successes. While health care reform evolves, the National Council is focused on moving a practical actionable 2009 agenda that includes single points of accountability for continuity of care for people with serious mental illnesses and addictions, cost-based-plus financing that supports clinical excellence, a federal mental health funding stream dedicated to mental health and integrated treatment services for the uninsured, funds to support investments by behavioral health care organizations in information technology, and support for research-based education and prevention practices. [ABSTRACT FROM AUTHOR]