Pediatric training programs are faced with rapid, fundamental changes in hospital practice and an increasingly rigorous regulatory and fiscal environment. Traditional models for providing care and teaching students and house officers may not be sufficiently responsive to these challenges. In 1986, the Department of Medicine at Children's Hospital, Boston, reorganized the general inpatient program and implemented a “service chief” system adapted from British hospital “firms.” Three age-based inpatient services (Thomas Morgan Rotch infant/toddler service, Kenneth Daniel Blackfan school-age service, and Charles Alderson Janeway adolescent/young adult service) were created, each headed by an experienced clinician and teacher (service chief). The service chiefs developed age-appropriate curricula, recruited a balanced faculty of generalists and specialists to serve as attending physicians and provide teaching in their areas of expertise, and established strong collaborative relationships with nurse managers on their respective wards. Implementation of the service chief system has been associated with development of faculty esprit de corps , standardized tracking of faculty performance, enhanced supervision and counseling of housestaff, and improved continuity of patient care. Relationships with referring physicians have improved dramatically, as measured by formal satisfaction surveys. Accountability and documentation have been emphasized, and departmental billings have increased sharply. Ongoing quality indicators have been developed, and collaborative patient care, teaching, and quality-improvement projects have been initiated with the nursing staff. Naming the services for distinguished past physicians-in-chief has provided a focus for fund-raising. Although an additional objective of the service chief system was to provide a framework for general pediatric clinical research by housestaff and service faculty, this goal remains largely unrealized. It is concluded that the service chief system is an efficient, effective strategy for providing quality patient care and teaching while meeting the fiscal and administrative burdens of contemporary hospital practice.
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机译：儿科培训计划面临医院实践的快速，根本性变化以及日益严格的法规和财政环境。传统的提供照料和教学生和房屋管理员的模式可能不足以应对这些挑战。 1986年，波士顿儿童医院内科进行了整体住院计划的重组，并实施了由英国医院“公司”改编的“服务负责人”系统。创建了三个基于年龄的住院服务（Thomas Morgan Rotch婴幼儿服务，Kenneth Daniel Blackfan学龄服务和Charles Alderson Janeway青少年/年轻成人服务），每个均由经验丰富的临床医生和老师（服务负责人）领导。服务负责人制定了适合年龄的课程，招募了平衡的通才和专家，担任主治医师并提供其专业领域的教学，并与各自病房的护士经理建立了牢固的合作关系。服务负责人系统的实施与教师队伍的发展，教师绩效的标准化跟踪，加强对人员的监督和咨询以及改善患者护理的连续性有关。通过正式的满意度调查，与转诊医生的关系得到了显着改善。强调了责任制和文件编制，部门帐单急剧增加。已经制定了持续的质量指标，并与护理人员一起开展了患者协作护理，教学和质量改进项目。为过去杰出的主治医生命名服务是筹款的重点。尽管服务负责人系统的另一个目标是为住宿服务人员和服务教职人员提供一般性儿科临床研究的框架，但这一目标在很大程度上仍未实现。结论是，服务负责人系统是一种高效，有效的策略，可在满足当代医院实践的财务和行政负担的同时，提供优质的患者护理和教学。
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