Just thinking, along the lines of a New Year’s resolution. What if all
of the hospitals in the Boston metropolitan area — academic medical
centers and community hospitals — decided as a group to eliminate
certain kinds of hospital-acquired infections and other kinds of
preventable harm? And what if they all committed to share their best
practices with one another and to engage in joint training and case
reviews in these arena? And what if they all agreed to publicly post
their progress on a single website for the world to see?
Let’s start simply.
My candidates:
1 — Eliminating central line infections (Metric: The number of CLIs, as defined by the CDC. Goal = 0)2 — Adopting the IHI bundle to help avoid ventilator associated pneumonia (Metric: Percent compliance with the bundle. Goal = 100%)3 — Adopting the WHO protocol
developed by Brigham and Women’s Hospital’s Atul Gawande for surgical
procedures (Metric: Percent of surgical cases in which the pre-op,
time-out, post-op checklist has been followed. Goal = 100%)
The
medical community in Boston likes to boast about the medical care here,
but we don’t do a very good job holding ourselves accountable. This
would be a terrific way to prove that we are serious about reducing
harm to patients and that we can cooperate across hospital lines for
the greater good.
Paul Levy is the President and CEO of Beth Israel Deconess Medical
Center in Boston. He blogs about his
experiences at, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive.
Filed Under: Uncategorized
Tagged: Patient Safety, Paul Levy, Quality, The DC, Transparency Jan 3, 2009
Paul,
I just read the comments on the same post on your blog. I’m surprised you really think that there is no competitive downside for other hospitals in the region to participate in this type of initiative. Think about the business risk for MGH if they participated along with 10 other hospitals? What if MGH finished 10th in 2009? And again in 2010? And after some highly visible quality improvements, they only moved up to 8th in 2011? Why would MGH taken on this business risk when they are already perceived as having the best care? Its just not realistic.
I admire your attention to these issues, because they are forward-thinking, patient-centric and focused on improving quality while lowering costs. From a policy perspective, its great that you’re raising awareness of these issues. But if I was a Board member, I’d want to how you are translating the quality improvements at BIDMC into a competitive advantage in the marketplace. Think out of the box. Partner with other similarly situated #2′s in your marketplace– Tufts Health Plan, Harvard Pilgrim, other second-tier hospitals and re-brand “quality care” in Boston. It could be a win-win for you and partners with both gaining market share from patients with a newfound appreciation for quality being found in other places than Partners or BCBS. There are other potential solutions along these lines.
While I agree that Partners may not perceive it as in their interest to post this data voluntarily, there is nothing to stop regulators from requiring it if they think it would contribute to the transparency movement and, more importantly over time, lead to more efficient healthcare resource allocation and lower overall costs.
Agreed, Barry: it makes sense that regulators could require the information on the grounds that it supports efficiency and thus lower overall costs. Gotta know what’s working and what’s not, right?
And gosh, it might even produce better outcomes for patients, of all things. (That’s you and you and you, in case you forgot! And your kids and parents.)
Hats off to Paul for laying down the gauntlet of accountability for these significant hospital induced causes of morbidity and mortality that largely escape the radar of public scrutiny. Having received provider training at an MGH facility I recall the luxury of boasting about it and Boston‘s academic quality, but shouldn’t the business case for quality include actual willingness to put “skin in the game” via transparency vs. just resting on historic perception about quality?
Paul’s proposal would also encourage providers out of internally focused silos to formulate a national conversation and goal of healing, (while hopefully also enabling and delighting patients) at the lowest possible cost.
It’s interesting that a post about transparency (aimed at benefiting patients) so quickly turned to a debate about the potential for inciting spitting contests between hospitals (aimed at puffing up professionals). I believe Paul Levy is passionate about transparency; unfortunately, my experience as a patient at BI and two Partners hospitals is that transparency is an expensive spin campaign to resurrect Boston’s lost reputation as the medical mecca it was 20 years ago. I went to another city after they crippled me in Boston and then lied about it.
If you are someone that works with children on Medicaid, join us in our New Year’s Resolution by promoting the importance of a proper health screening for kids -
http://ourhealthcaresource.com/2010/12/28/a-new-year%E2%80%99s-resolution-to-help-our-children-stay-healthy/