The New Health Dialogue

As our blog creator Joanne Kenen noted recently, delivery system reform advocates are pondering the ten year anniversary of  the landmark Institute of Medicine report, “To Err Is Human,” We are wondering how far we’ve come since learning that anywhere between 44,000-98,000 Americans die every year due to preventable medical errors. 

The answer: we’re not sure.

That’s according to Dr. Bob Wachter, hospitalist physician, blogger, and author, who recently published a ten year report card in Health Affairs on how  the health system has responded to the IOM report. He, along with George Reuther, chief operating officer of the Healthcare Facilities Accreditation Program, (similar to the Joint Commission, but accredits osteopathic hospitals), participated in an hour-long webcast forum hosted by Modern Healthcare. 

Dr. Wachter’s article grades the health care system in ten patient safety domains and he chose four to highlight during the webcast: regulation/ accreditation, reporting systems, health IT, and balancing “no blame” with accountability.

Regulation/accreditation gets a B+, down from an A- in 2004. These are blunt tools and he worries that “all the low hanging fruit has been picked,” according to his article. 

Reporting systems get a B+, up from a C in 2004. Simple reporting can lead to major improvement, because a hospital can’t fix what it doesn’t measure. Despite the fact that evidence supporting the original proposal linked to this domain -- consumers making decisions based on reporting about their local providers -- has failed to materialize, Dr. Wachter has found that feelings of shame or pride in scores have led providers to improve. 

Health IT gets a C+, down from a B- in 2004. He said it was “shocking” how little health IT has been used to increase patient safety in the last five years. It’s expensive, and ideas that all health systems could reap the same benefits of long-wired hospitals did not materialize, perhaps due to issues associated with adopting vendor-based systems. IT can also produce safety problems during the transition period when clinicians adjust to the new system.

Balancing “no blame” with accountability gets a C+, up from a D+ in 2004. Most errors can be improved by improving systems, but there needs to be a clear demarcation of blameworthy acts – such as failure to heed reasonable safety rules, like timeouts before surgery or hand washing compliance.

Dr. Wachter summed up the last ten years borrowing from Winston Churchill (or was it the Rembrandts?): it’s the end of the beginning. Real progress has been made, but we cannot be sure how much safer we are because safety errors must be largely self-reported and therefore are difficult to measure. 

Mr. Reuther reminds us of the Michigan Health and Hospital Association (MHA) Keystone: ICU collaborative, which has saved nearly 2,000 lives during the past five years by reducing central line-associated bloodstream infections and ventilator-associated pneumonia. The collaborative is expanding to attempt reductions at sepsis mortality, better glucose control, and exploring the business case for a safer ICU.

The webcast will be posted to the Modern Healthcare website on Friday December 11 and will be free to watch/listen for one week (after that it will only be available to subscribers).