Improving Health Care Quality, Safety Defies Simple Solutions
Health Affairs commentary by Joint Commission President & CEO
October 10, 2013
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(OAKBROOK TERRACE, Ill. – October 10, 2013) A viewpoint published in the October 2013 issue of Health Affairs contends that American health care will not get better or be safer until issues related to overuse of health services, process improvement tools, and organizational culture are addressed. The article “Improving the Quality of Health Care: What’s Taking So Long?” by Joint Commission President and CEO Mark R. Chassin, M.D., FACP, M.P.P., M.P.H., acknowledges that the lack of more rapid progress in fixing known problems is frustrating, and suggests that the task requires new approaches.
Nearly 14 years after the Institute of Medicine report To Err Is Human; Building a Safer Health System jolted health care professionals and the public alike by revealing that preventable health care adverse events cause more deaths than traffic accidents or breast cancer, Chassin contends that the way health care conducts improvement is itself in need of improvement. His Health Affairs commentary builds on his previous efforts to help health care make progress toward high reliability, which represents an extraordinarily high level of safety sustained over long periods of time – safety levels achieved today by industries such as commercial air travel, nuclear power, and amusement parks. Chassin proposes three strategies:
Eliminating overuse of health services – Looking beyond preventable complications such as health care-associated infections and adverse events such as wrong site surgery, avoiding tests, treatments, and procedures that do not provide significant benefit has the potential to both improve quality and reduce costs. Antibiotics for colds and early elective deliveries without a medical indication are examples of overuse.
Recognizing that one size does not fit all – Using process improvement tools and methods, such as Six Sigma, Lean, and change management (known together as Robust Process Improvement™ or RPI), could offer hospitals and other health care organizations solutions that are unique to their circumstances. This approach differs from long-standing efforts that emphasize evidence-based guidelines, checklists, and toolkits that are typically not customized. Instead, Chassin notes that RPI provides new ways of examining complicated problems such as hand hygiene failures and discovering highly effective, targeted interventions.
Creating a culture of safety – Putting a stop to intimidating and disrespectful behaviors could help encourage candid reporting of and dialogue about errors, close calls, and unsafe conditions. Facilitating reporting and learning from blameless errors and unsafe conditions does not, however, eliminate the need for personal responsibility. Chassin contends that accountability for adhering to agreed-upon safe practices is a key component of a culture of safety. Willful failure to follow safety rules should lead to appropriate disciplinary action—no matter who commits the violation.
“Harm-free health care does not exist today, but that should not prevent us from aspiring to achieve that goal,” says Chassin.
Chassin’s proposals to improve health care come more than two years after he and the late Jerod M. Loeb, Ph.D., executive vice president for health care quality evaluation, The Joint Commission, collaborated on the article “The Ongoing Quality Improvement Journey: Next Stop, High Reliability,” also published by Health Affairs. The April 2011 article contended that health care could make major improvements in quality and safety by adapting lessons learned from other industries with consistently excellent safety records. They recently followed up on the April 2011 piece with a second article “High-Reliability Health Care: Getting There from Here,” in the September 13 issue of The Milbank Quarterly, that provides a roadmap of specific changes hospitals should undertake to achieve the ultimate goal of zero patient harm by adapting lessons from high-risk industries.
The Joint Commission is leading this effort in its work with more than 20,000 accredited health care organizations. Joint Commission standards (Leadership, National Patient Safety Goals, Quality Improvement) emphasize the need to create a culture of safety and to continuously improve performance. In addition, the Joint Commission Center for Transforming Healthcare is helping health care organizations use RPI to create customized solutions to quality and safety issues such as hand hygiene, reducing errors in hand-offs between caregivers, wrong site surgery, surgical site infections, preventing falls that injure patients, and others.