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General interest items edited by Janice Flahiff

[Reblog] How Many Patients Did We Hurt Last Month? Learning (But Not Too Much) From The Best Hospitals

From the 6 November 2013 HealthCare Blog post by ASHISH JHA, MD

A few years ago, I was working on a strategy for improving the quality and safety of VA healthcare.  As part of this effort, I called up senior quality leaders of major healthcare organizations across the nation.  One call is particularly memorable.  Because I promised anonymity, I will not name names but this clinical leader was very clear about his responsibility: every month, he met with his CEO, who began the meetings with three simple questions: “How many patients did we hurt last month? How many patients did we fail to help? And did we do better than the month before?

The CEO and the entire hospital took responsibility for every preventable injury and death that occurred and the culture of the place was focused on one thing: getting better.  When I looked them up on Hospital Compare, they too had excellent outcomes and they regularly get “A” ratings for patient safety from the Leapfrog Group.

 

How do the BIDMCs and these other super-high performers pull it off?  How do they build a culture of quality when so many organizations seem to struggle?  High performance is complex, of course, and I won’t try to be overly simplistic.  But a few things seem common among many high performing institutions. They seem to be focused on three things:  timely, clinically relevant outcomes data; transparency within (and usually outside) the organization; and a constant focus on getting better.

You can see the kinds of data that BIDMC posts on its website – it’s not just the standard Hospital Compare stuff (which everyone has to do) but other data on a series of outcomes which are not required.   When I hear Kevin Tabb, their current CEO talk about quality – it’s obvious that quality is not a platitude.  He is genuinely focused on getting better.

So what’s the lesson from BIDMC, Mayo and other high performing institutions? There is no substitute for great leadership.  Each of them seems to have been blessed with leaders who, despite all the wrong incentives in the healthcare system, prioritize patient care and drive their organizations to great performance.  They are internally motivated and do all the things I describe above, despite the fact that our primary payment systems incentivize them to do more, not better.  They are extraordinary leaders- with not only great vision but also the ability to execute that vision.

But here’s the risk:  too many policymakers believe that all we need to do is figure out what BIDMC or Mayo or Kaiser does and just get everyone else to do it. Such an approach, while seemingly perfectly good on paper, fails to account for the human element.  The strategies that they have used have been executed by individuals unusually focused on improving care.  Barring substantial improvements in cloning technology, we can’t expect that each hospital will have a great leader.

We don’t expect that every technology company will have a Steve Jobs.  In every industry, there are a few visionary leaders, but the rest of the organizations?  They are run by mortals – and mortals respond to incentives.  And here lies the problem:  the incentives in the system are not motivating the typical CEO to improve care.  Whatever strategy we employ around timely data, transparency, etc. won’t work until the leadership is properly motivated and focused on quality.  And while that happens in pockets, it’s not happening across the entire healthcare system.  And this is where we will pick up in my next blog: how to get the rest of the organizations to make quality a real priority.

 

Read the entire article here

 

November 8, 2013 - Posted by | health care | , ,

1 Comment »

  1. […] [Reblog] How Many Patients Did We Hurt Last Month? Learning (But Not Too Much) From The Best Hospita… (jflahiff.wordpress.com) […]

    Pingback by How do hospitals build a culture of quality? | Clinic Notes | November 11, 2013 | Reply


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