Several weeks ago, I mentioned the retreat we held with the BIDMC and BID~Needham hospital boards to review the role and scope of the governing bodies of our organizations, as a precursor to establishing audacious quality, safety, and patient satisfaction goals for the two hospitals. In just a few weeks, the two boards will meet again, and I will be able to report to you on the overall direction voted by them. In the following months you will be able track our progress towards exacting, quantified goals.
Several days ago, I had a chance to visit with a board member from Cincinnati Children's Hospital about their self-improvement process, entitled Pursuing Perfect Care. This has been an extraordinary program, pervading the entire institution, and achieving great results. A key aspect of the process has been utter transparency about the organization's progress towards its goals. Check this page for a summary of the operational definitions of the items that are measured and reported upon publicly. As I have noted elsewhere, transparency is not a matter of trying to create a competitive advantage for one hospital versus another. It is a way of holding one's own organization accountable to itself and to the public.
In the last several days, executives from several of the state's insurance companies have made suggestions regarding cost control of medical expenses in Massachusetts. As reported by our friends at Health Care for All, they suggested legislation that would include the following items:
1. Public Reporting of Preventable Errors and Prohibiting Billing for Avoidable Mistakes
2. Strengthening the Determination of Need Process
3. A Special Commission to Study State-Funded Stop-Loss Coverage
4. Allow for the Operation of Limited Service Clinics
5. Medical Malpractice Reform
6. Require Electronic Transmission of Health Care Transactions
7. Repeal Mandated Benefits that are no Longer Effective
8. Comparative Effectiveness Studies of Medical Services
9. Extend the Moratorium on Mandated Benefits
10. Permit Mandate-Lite and Mandate-Free Products
11. Hospital Reporting on Measures to Reduce Duplicative Diagnostic Services
12. Hospitals Reporting on Measures to Eliminate ER Diversions and Overcrowding
13. Make Greater Use of Managed Medicaid
14. Eliminate Duplicative Regulatory Requirements
15. Standardized Reporting Requirements
16. Streamline Administrative Processes
17. Standardize Physician Credentialing
Perhaps some of these might be good ideas in their own right, but they do not get at the underlying structural problem in the delivery of care in hospitals. This is not to say that hospital costs are the sole or main determinant of cost increases in health care, but they are admittedly an important part of the trend. We do not need to wait for legislation to make improvements.
The clear message from my colleague in Ohio was this: THE most significant step hospitals can take to improve cost-effectiveness is to reduce harm to patients in their institutions by adopting aggressive quality and safety goals, measuring their success towards them, and reporting on their progress to the public. Not that we should need an economic argument to do a better job for patients, but it is good to know that two go hand in hand. We intend to pursue this agenda with all due energy at BIDMC and BID~Needham.