Time for physicians to reconfigure.

The days when medical professionals made unilateral patient-care decisions are gone. Accelerating trends are converging to create a climate for what we call "consumer-centric healthcare," and that raises new and unsettling questions for physicians.

Quality improvement, housestaff, and the role of chief residents.

Purpose: Little is known about the role of chief residents in utilizing and promoting continuous quality improvement (CQI) and quality assurance (QA) methods with housestaff. The purpose of this study was to ascertain how chief residents could be involved more formally in improving the quality of care in a major public teaching hospital.

Method: Fourteen chief residents on the major services at Boston City Hospital participated in early 1994 in either a focus group or an individual interview.

The need for a new model of care: revisiting the archetype.

Managed care organizations are refusing to accept the traditional academic health center's uncoordinated teaching model for their patients. They know that successful capitation can only be achieved when care is viewed from a population perspective, managed along a continuum, and coordinated at every point. Of the many changes that must occur, the care delivery paradigm, is a major area that needs to be redesigned.