HOSPITALS/QUALITY: A quiet little speech by Michael Millenson

Millenson on the lack of real committment to patient safety. Acerbic and fantastic. A few quotes, but as they say in the blogosphere read the whole thing

If there is a quality crisis today, it certainly is not apparent from the actions of major stakeholders….


…on the fifth anniversary of the IOM report, the Institute for Healthcare Improvement launched its "Save 100,000 Lives Campaign." It is a wonderful campaign, even if four out of every 10 hospitals don’t participate. What does that say about the will to change?

…Imagine what might happen in the QI world if the head of the IOM publicly criticized by name those 40 percent of hospitals that declined to participate in the IHI safety initiative. Imagine if Congress reacted by holding hearings. Imagine if CMS asked the Joint Commission to investigate whether those hospitals were really as safe as they seemed to think they were. Imagine if there were class-action lawsuits filed. Imagine the impact this unprecedented kind of focused, multi-faceted pressure would have on the "will to change" and the cultural context of quality improvement. If you find this scenario unlikely, it may be because those promoting the quality agenda sometimes seem to display greater concern for those whose behavior they are trying to change than for those whom that behavior is hurting.

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3 replies »

  1. The lack of will Dale describes is, imo, caused by a combination of human frailties (fear, self-deception, ego, ignorance, inertia, etc.) and a broken healthcare system operating within an economic system (American politicized capitalism) that has lost its way in search for ever-increasing concentration of wealth rather than asserting social responsibility. As CQI becomes a business differentiator for competitive advantage, we will see major transformations in the healthcare system. Fortunately, we’re in the early stages of such transformation, but much much more has to be done to make a sustainable difference. One potential path is through development of university-centered RHIOs whose providers focus on continuous quality improvement through implementation of evolving evidence-based guidelines.

  2. This is an amazing speech. I am a firm believer in evidence-based medicine (being a healthcare consumer rather than practitioner) and can see many was information technology can implement and enhance it. I have always assumed (naively it is clear) that the reason it wasn’t more widely adopted was ignorance of the possibilities. Now it is clear: the reason is lack of will. The facts have been known for a long time, evidence for the benefits of addressing the problem of QI irrefutable, but it is apparently in no one’s short-term best interests to address the problem, particularly not our elected officials and their appointed civil servants.
    Makes one proud to be an American, n’est-ce pas? 😉