Reform must include investment in quality
Published in Modern Heathcare Online, July 22, 2009
All we need to do to find sufficient funds to extend health insurance to all Americans is to make health care as safe as commercial air travel. Eliminating the preventable complications that today harm millions of patients would easily save the many billions of dollars lawmakers are struggling so hard to locate. And, as a bonus, the health of patients who do not suffer those complications will increase, too. Simple, right? Yes. And, no.
The first part of the argument is not in doubt. Avoidable injuries from medications, preventable infections, surgical complications that should not occur, and problems resulting from poor communication among health care providers cost hundreds of billions of dollars each year. Nor is this a complete list of our health care quality and safety problems. If you add in the consequences of the inappropriate use of health services (think antibiotics for colds), the possible savings are staggering.
Is truly safe health care a science-fiction fantasy, or an achievable goal? Answering this question is where the simplicity ends.
As President Barack Obama and Congress wrangle over how to reform the health care system, let's not lose sight of one of the most urgently needed reforms: quality improvement.
Americans do not understand why routine safety processes break down in health care facilities. They don't understand why doctors and nurses and technicians in hospitals and nursing homes don't wash their hands every time they should. They don't understand why, when family members are admitted to a hospital, they have to tell their story to the first nurse they meet and the second nurse and the first doctor they meet, and the second doctor and still the medications may be wrong. They don't understand why these routine, common-sense safety processes do not perform with near-100% reliability. People are getting impatient with the slow pace of improvement in patient safety.
The key to transforming our health care system into one in which patients can feel confident in the safety of the care they receive is to incorporate proven quality improvement methods already in use in other environments into the delivery of health care. Other industries and organizations that deliver goods and services to consumers (think U.S. nuclear power) have developed robust quality improvement strategies that work. Many such organizations manage risks every bit as hazardous as those in health care but with much higher levels of safety. Yet the health care system has been slow to adopt these proven approaches to successful results.
What exactly is “robust process improvement”? The core principles involve identifying the problem to be solved; defining precisely a successful goal; measuring performance in relation to that goal; assessing the causes of the organization's shortfalls; implementing interventions targeted to the most important causes; and embedding effective interventions into the everyday work of caregivers so that they are sustainable.
Addressing the capacity of organizations to deliver this kind of robust process improvement is the only way that health care can keep up with the ever-changing, moving target of quality and safety. Creating and sustaining improvement is difficult and, unfortunately, not all health care organizations have the capability to do it today. Until we can build this capacity throughout the system, we should invest in ways to harness the expertise we do have to create scalable and specified solutions that organizations of all sizes and complexity can easily adopt to combat our most serious and thorny patient safety issues. This will give health care providers tools essential to delivering cost-effective care, eliminating preventable complications and achieving significant reductions in health care-acquired infections, re-hospitalizations and unnecessary tests.
I urge President Obama and Congress to invest in an infrastructure that will allow health care to achieve robust process improvement. I applaud the Senate Affordable Health Choices Act for recognizing the need for quality improvement. But I hope that as the health care reform debate continues, we will not lose sight of this goal and will aim our sights even higher. Without such a commitment, health care reform will not meet consumer expectations.
Can we rise to the challenge of transforming health care into a high-reliability industry, with rates of adverse events and routine safety process breakdowns comparable to or better than air travel or any other high-reliability industry? Are we up to it? I believe we must be. That will be true reform.
Mark R. Chassin, M.D.
President of The Joint Commission