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The Hospital: Still the Doctors' Workplace(s)A Cautionary Note for Approaches to Safety and Value Improvement

Medicare has long stood at the center of efforts to embrace value payment, enhance quality, and improve the health of the population. Implementation efforts within Medicare have often focused on the hospital. Hospitals may seem at first glance to be appropriate places on which to focus. They are iconic elements of the health care system. They are prominent—frequently the largest employer in any community, often a source of community pride. They are familiar—whether people come as patients or visitors, frequenting the hospital is a common experience. People who work there include doctors, nurses, pharmacists, and other health care workers, many of whom are notable members of the community. Hospitals are often taken to symbolize (and indeed, to operationalize) the powers of modern medicine. Most people are born in hospitals, and many die there. Finally, for those hoping to change the health care system, whether by implementing new payment policies, enhancing quality/safety, or creating new public policy models, hospitals represent a manageable number of “targets.”

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