What is the important thing Don Berwick could do as head of CMS to improve quality and reduce the cost of health care? Let’s face it, as head of a humongous agency, it is hard to make changes. You have to pick your battles carefully, for every cause has a constituency and an opponent. Gridlock is a fact of life in Washington, DC: The system is designed for that result.
Let’s just say, though, that you had a chance to adopt one innovative regulation or proposal, one where even opponents would have little moral ground on which to get traction.
Announce that you are going to create a website in which each hospital is invited to input two or three real-time metrics with regard to reducing harm. Let’s start with central line infections. There is a common definition provided by the CDC. Many hospitals keep track of their rate of infection.
Provide a password-protected template and give each hospital CEO (yes,
CEO!) the opportunity to send in his or her hospital’s quarterly figure
for the world to see. Set up the web page so the accumulated sequence
of numbers is translated in a trend line, so anyone can watch a given
hospital’s progress over time.
Why the CEO? Well, as noted in a recent Washington Post story: “[Peter] Pronovost said part of the problem was that many hospital chief executives aren’t even aware of their institution’s bloodstream infection rates, let alone how easily they could bring them down.”
Here is an example, the web page used by our hospital.
Notice that I am not proposing any audit procedure. I am not proposing any financial incentive or any reward or sanction for participating or not participating.
I am not proposing that numbers be adjusted by relative risk, size of hospital, geographic location, or anything like that. The trend line is the key: Each hospital will be competing against its own record, not that of other hospitals
I am proposing a kind of transparency that will bring credit to the participants because it would indicate that they are willing to be held accountable to a high standard of clinical care. This is what motivates doctors and nurses. Not dollars.
Don has the bully pulpit. He will only get a few chances to use it. Power is Washington is ephemeral. Don can use the power of his office to tap the real power — the good intentions of clinicians who have devoted their lives to alleviating human suffering caused by disease. He can give them a forum to show their stuff.