Tuesday, December 02, 2014

Falling behind on safety and quality in the Hub of the Universe

I'm sitting here in Massachusetts trying to reconcile two stories.  First, this optimistic one put out by AHRQ, reported by Modern Healthcare's Sabriya Rice.  The lede:

The Agency for Healthcare Research and Quality estimates that 1.3 million fewer patients were harmed in U.S. hospitals from 2010 to 2013 amid focused and widespread efforts to reduce surgical-site infections, adverse drug events and other preventable incidents.

The decline represents cumulative 17% reduction and an estimated 50,000 deaths prevented over the three years after the launch of the Partnership for Patients, a public-private collaborative created with funding from HHS.

“This is an unprecedented decline in patient harm in this country,” said CMS Deputy Administrator Dr. Patrick Conway. “This means avoiding costly mistakes and readmissions, keeping patients healthy and out of the hospital and rewarding quality instead of quantity.”

I read that report and said, "Hmm, that doesn't jibe with what I see in Massachusetts." And then I read this less positive report by Kay Lazar at the Boston Globe:

The 1994 death of Betsy Lehman, a Boston Globe health reporter who received a massive overdose of chemotherapy at a prestigious Boston cancer center, galvanized health leaders to reduce errors in medical care.

But two decades later, nearly one-quarter of Massachusetts residents say they, or someone close to them, experienced a mistake in their care during the past five years, according to a survey released Tuesday. And about half of those who reported a mistake said the error resulted in serious health consequences.

The poll of 1,224 residents by researchers at the Harvard School of Public Health found that many people did not report the medical mistakes, often because they did not believe it would do any good, or they did not know how to report it.

“When you are trying to reduce incidents, and 20 years later you still have a significant number of people who report a significant event, it sets off concerns,” said Robert Blendon, a Harvard professor of health policy and political analysis, and the poll’s director.

That story was less surprising to me.  Why?  One of the problems in Massachusetts remains hospitals' stubborn failure to acknowledge the harm they cause.  A few years ago, for example, when I was posting BIDMC's central line-associated bloodstream infection rates, a reporter asked the CEO of one of the other Harvard hospitals when he was going to do the same.  His cynical response;  "We'll post our numbers when we're good and ready . . . but our numbers are better than theirs."

True clinical process improvement does not happen without true transparency--not to compare one hospital against another, but to help hospitals hold themselves accountable to the standard of care they say they believe in.  Endorsement of real-time, relevant transparency by Massachusetts hospitals' clinical and administrative leaders, and their boards of trustees, remains sorely lacking.  What's published is often out of date and put in terms of some substandard national benchmark, rather then being directed at eliminating preventable harm.

There is no virtue in benchmarking yourself to a substandard norm.  I once quoted Catherine Carson, Director, Quality & Patient Safety at Daughters of Charity Health System: 

When the goal is zero – as in zero hospital-acquired infections, or falls – why seek a benchmark? A benchmark would then send the message  - that in comparison to X, our current performance level is okay, which is a false message when the goal of harm is zero.

A colleague from another state noted to me upon reading Kay's story: "I have to say this is pretty shameful for a state dominated by academic medical centers."

Ironically, some of the world experts in these matters are faculty members in our local hospitals. Massachusetts should be a world leader in the science of health care delivery, along with the fields in which it already holds prominence.  But it is nowhere close to holding that title.  The action is elsewhere in the country. The state's hospitals are being left in the dust, to the detriment of thousands of people living here.


Anonymous said...

Amen. As a patient who sees this daily, until you force these people to do something, they will not do it.

Fred said...

You won't find this in Ms. Rice's story (not unusual for MH) but the total sample size behind the HHS announcement (first attachment, pg. 3) is "18,000 to 33,000 medical records in each year." However, we have (nationally, all-in) north of 40 million hospital discharges a year (second attachment, pg. 13). Statistical significance?

Cheryl Handy said...

As part of the hospital discharge package, there should be a form that patients (or their families) can complete and send to HHS. Patients should be allowed to report errors. Then, the HHS can review and decide whether there was a medical error. Patient generated error reports would not only increase the data but would also show trends with respect to specialties, doctors, hospitals, patient stats.

In addition, I recall how excited we all were with CMS' introduction of "never events." The idea was that hospitals would reduce errors of infections, falls, bed sores, quick readmits because CMS would not reimburse. How naive we were. Now, hospitals and docs just ignore falls and refuse readmits and blame patients for hospital bore infections. The bottom line of reimbursements shadowed the issue of patient safety.