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HOSPITALS: These things happen By Paul Levy

Paul Levy is the President and CEO of Beth Israel Deconess Medical Center in Boston. Paul recently became the focus of much media attention when he decided to publish infection rates at his hospital, despite the fact that under Massachusetts law he is not yet required to do so.  For the last year and a half he has blogged about his experiences in an online journal, Running a Hospital, one of the few blogs we know of maintained by a senior hospital executive. Today Paul writes about some of the reasons he decided to publish data on central line infection rates and the (adverse) reaction his decision stirred up among competitors in Boston.

These things happen … I was reminded of this by our Chief of Medicine. In the movie, "It’s a Mad, Mad, Mad, Mad World," Ethel Merman, playing Mrs. Marcus, says:

Now
what kind of an attitude is that, ‘these things happen?’ They only
happen because this whole country is just full of people who, when
these things happen, they just say ‘these things happen,’ and that’s
why they happen! We gotta have control of what happens to us."

I am struck by the relevance of this to running a hospital.

Several
years ago, we had that attitude in our hospital with regard to certain
types of medical outcomes. For example, we were content with our level
of central line infections because we were below the national average.
After all, these things happen. Then our chiefs of medicine and surgery
said, "No, they don’t have to happen. When they happen, people die. We
are going to insist that we achieve zero central line infections." And
then they got to work. As I have noted below, it is not an easy problem
to solve, but it is worth the effort, and you can improve.
One way to encourage organizational improvement is to publicize the results of your program. I have done that below
for our hospital, and I have made the suggestion that others in the
city could do the same. As I noted, I did not make the suggestion for
competitive purposes — after all, I don’t know if our numbers are
better or worse than those of other hospitals — but because public
exposure of all our efforts will drive all of us to do better. Also, it
will build, rather than erode, public confidence in the academic
medical centers in our city.

The
response, as you have seen from the press reports, ranges from simple
recalcitrance to technically sophistic arguments about comparability of
data. Please, does anyone argue that the goal should not be zero? If it
is zero, it does not matter whether the data is measured in cases per
thousand patient-days, cases per thousand catheter-days, or just the
raw number of cases.

We all
keep track of these numbers in some form or another. We could easily
post them in real time voluntarily on a website maintained by the state
or an insurance company, along with our own explanations of how and
what we measure. (And perhaps, over time, we will agree on what single
metric is most useful.)

People can and will understand this. They already spend hours on the Internet
reading medical websites. Why do we give them so little credit? It will
demonstrate to the public that we care about this problem, and will
show our individual progress towards our ultimate goal.

Finally,
it will enhance the reputation and credibility of all of the academic
medical centers, two aspects of our character that will be more and
more under siege because of the broader problems of the health care system.

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I think he is dead right, and supported by the book “Redefining Health Care: Creating Value-based Competition on Results”. See my comment on his blog post for further info on this book (I’m tired of retyping) Those who favor a single-payor approach (jack? (:) would do well to read it.
bev, M.D.