Continuing problems with errors spur group to launch $500 million safety initiative
Imagine a hospital where the intensive-care unit's myriad devices are linked and seamlessly exchange data, where patients' families use iPads to track clinicians' real-time adherence to evidence-based guidelines, and where a patient's loss of dignity is viewed as a preventable harm on the same order of magnitude as a fall or a bloodstream infection.
It might sound far-fetched to some, but the Gordon and Betty Moore Foundation, a charitable organization based in Palo, Alto, Calif., is betting that those changes are feasible now and can go a long way toward transforming the healthcare system.
On Aug. 28, the foundation officially launched its Patient Care Program, a grant-making initiative set to allocate as much as half a billion dollars during the next decade toward eliminating patient harm.
Adverse events affect as many as 1 in 3 patients, and the resulting harm causes tens of thousands of patient deaths each year and costs the healthcare system billions. And despite improvement efforts, mounting evidence points to high rates of complications and preventable deaths
Numerous large-scale initiatives have been undertaken in recent years to address the problem, including HHS' Partnership for Patients, a $1 billion campaign launched in April 2011 that aims to reduce hospital-acquired conditions, improve transitions of care and reduce Medicare costs by up to $50 billion over 10 years.
But the leadership of the Gordon and Betty Moore Foundation say their initiative's two-pronged approach, which emphasizes meaningful patient and family engagement as well as reengineering of hospital systems and processes, is what sets it apart. “By developing and connecting these two critical aspects of healthcare, we believe that healthcare will be better, more cost-effective and more respectful for patients and their families and the healthcare professional who serve them,” Steven McCormick, the foundation's president, said in a news release.
A core tenet of the program is the idea that teaming industrial engineers and other professionals with clinicians will enable hospitals to create high-reliability systems, thereby removing the need to rely on individual acts of heroism to achieve good outcomes, said Dr. George Bo-Linn, the Patient Care Program's chief program officer. And smartly designed, reconfigured systems will give physicians and nurses far more time to communicate with patients and their families, a critical and often-untapped resource in providing high-quality care, he added.
Even well-intentioned clinicians often think they know what patients want, James Guest, president and CEO of Consumers Union, said at a foundation event for the program's launch. “But you don't really know what patients want unless you ask and listen, unless you really pay attention without preconceived notions,” he said. “Every patient needs to be listened to.”
Bo-Linn cited research that found that nearly half of patients report feeling a loss of dignity and respect when dealing with the healthcare system. “If someone gets an infection and it heals, the physical part is gone,” he said. “But if patients feel like they were not listened to, like they could not speak up, that loss of dignity will last far longer. And those patients will likely not want to engage further in advocating for a healthcare delivery system that delivers on the promise of safe care.”
The Patient Care Program also is unique because it doesn't target specific types of harm, said Dr. Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality at Johns Hopkins University, Baltimore. Instead, it starts with an end point in mind—eliminating all types of preventable harm, beginning in the ICU setting—and works backward from there, he said.
Pronovost is well-known for a program he led that significantly reduced rates of central line-associated bloodstream infections. But even that work focused on only one type of harm, and the protocols it requires are an added burden for busy clinicians, he said.
The foundation kicked off the initiative with an $8.9 million grant to Johns Hopkins' Armstrong Institute to improve ICU care.
Pronovost, who will lead the effort, said the money will be used to create a “a mini-Bell Labs” that will draw expertise from the university's schools of medicine, nursing, engineering, public health, business and applied physics to re-imagine care.
The goal is to create an ICU where monitoring devices, infusion pumps and other machines can “talk” to each other and make adjustments as needed, treatment plans—sometimes consisting of as many as 200 steps—are standardized and automated, and information technology systems alert clinicians to risks of harm.
As part of that effort, researchers will design open-source middleware that will link ICU devices. Pronovost said he envisions an ICU in which patients' families make rounds with physicians, assess treatment plans and provide feedback.
Patient-safety experts lauded the program for its systems approach and for its emphasis on patient and family empowerment. Diane Pinakiewicz, president of the Boston-based National Patient Safety Foundation, praised the foundation's reputation for funding forward-thinking and scalable projects. “Their dedication to patient dignity is so refreshing,” she said. “Patients and their families have not been welcomed to the conversation in the past and that has been a missed opportunity.”
She also said the program's target of “zero harm” is the right one. “That's exactly the end point we need to have in our minds at all times,” she said.
It's not the first time the foundation has addressed healthcare safety. Created in 2000 by Intel Corp. co-founder Gordon Moore and his wife, the organization, whose assets total more than $5.5 billion, focuses on science, environmental conservation and patient care. In 2003, the foundation established the Betty Irene Moore Nursing Initiative, which has awarded more than $100 million in grants to improve nursing care in communities surrounding San Francisco and Sacramento, Calif.
But the Patient Care Program will run indefinitely and as a national program will be much larger in scope, McCormick said. The program also enlists the help of a number of strategic partners, including Consumers Union, Stanford University and UnitedHealth Group.
Researchers at the University of California at San Francisco also secured a $2.1 million grant from the foundation to study workflow patterns, interpersonal communication and other aspects of care in ICUs. Led by Dr. Scott Reeves, director of UCSF's Center for Innovation in Interprofessional Healthcare Education, the team will spend two years observing four hospital ICUs in each year. “We want to get a deep understanding of what really goes on in the ICU, what works well and what doesn't,” he said.
The Institute of Medicine and the National Academy of Engineering also are partnering with the foundation on the initiative, said Dr. J. Michael McGinnis, a senior scholar at the IOM. Their contributions will include providing a forum where professionals in medicine and engineering can learn more about their fields and find ways to collaborate, he said.
Dr. Donald Berwick, senior fellow at the Center for American Progress and former CMS administrator, said the Patient Care Program marks a maturation in the healthcare industry's approach to improvement. Berwick co-founded the Cambridge, Mass.-based Institute for Healthcare Improvement, whose systems-based approaches provided much of the foundation for the Patient Care Program.
“For the first couple of decades, the work in patient safety and process improvement focused on individual diseases and risks,” Berwick said. “That was an important time when we were cutting our teeth. What is happening now, though, is an understanding that excellence is a systemic property and that means being able to remake systems in their entirety. That's the next step for the quality movement.”
TAKEAWAY: A $500 million safety initiative is banking on the power of patients, families and engineers to transform care.