There's no room for doubt that the healthcare industry needs to improve patient safety, Robert Wachter, M.D., told the audience at the Institute for Healthcare Improvement's recent forum on the issue--and he has a few ideas about how to go about it.
"We are being pressured to change because we need to be pressured to change," Wachter, associate chair of the University of California at San Francisco's Department of Medicine and a patient safety expert, said in a recording of his remarks. "The care that we have delivered and the system that we have concocted does not reliably deliver high-quality, safe and affordable care."
The case for improving care quality has rarely been more pressing, with research indicating that medical errors cause as many as 400,00 deaths per year, FierceHealthcare has reported. One advocate has even called for a National Patient Safety Board to serve as a watchdog and curtail preventable deaths.
To that end, here's six of the 10 insights Wachter said healthcare leaders need to know to improve their care quality--and their business:
- It's a different world. The business case for safety and value in the healthcare industry did not exist when the watershed patient safety report "To Err is Human: Building a Safer Health System" came out in 1999, Wachter said. Today, with competitive pressure, accreditation, transparency and payment changes, that's no longer the case. Wachter estimates that 8 to 10 percent of hospital Medicare payments will hinge on performance by 2017, adding that the trend is not going away anytime soon.
- Leadership matters. While it's obvious that healthcare is a team sport, Wachter said he found "potentially concerning" the pressure to totally eliminate a hierarchy. "It's also important that we train and nurture leaders," he said.
- Think locally. "The answers to many of the questions that you're struggling with probably can be found under your roof," Wachter said, advising healthcare leaders to learn from successful care improvement strategies implemented by other arms of their own organizations.
- Money isn't the only motivator. Wachter challenges the notion that "all we need are more incentives" to improve the quality of care. In a helping industry like healthcare, he said clinicians are motivated by more than dollars. Ultimately, he cautions leaders not to dismiss pay-for-performance concepts such as those employed by Medicare, but not rely totally on them.
- People are as important as systems. The industry's narrow focus on improving the system as a whole has missed important safety factors that individuals must solve, Wachter said. For example, knowledge and clinical reasoning skills in doctors are crucial to cut diagnostic errors, and surgeons who display the most advanced technique produce the best outcomes in patients.
- Balance "no blame" mentality with accountability. Wachter further pointed out the limits of systems thinking, cautioning leaders not to remove blame for medical errors entirely from individuals. He used the example that most hospitals, after drastically improving their hand-washing compliance, are stuck at a rate of around 60 percent compliance despite pursing aggressive awareness campaigns. "At some point the system is good enough and it's an accountability problem," he said.
To learn more:
- listen to the recording (registration may be required)