Healthcare quality guru Don Berwick, M.D., likened the shortcomings in healthcare quality to the dark villain in the popular Harry Potter novels whose name most are afraid to say out loud. "Well, I'm not afraid to say his name," Berwick bravely told 3,000 attendees of the National Forum on Quality Improvement in Health Care last month in San Francisco. Everyone else with a stake in healthcare also seems to have gathered the courage to shout Voldemort's name.
Healthcare quality has attracted almost as much attention in the past few months as the release of J.K. Rowling's fifth novel. Among the developments:
* The Institute of Medicine is releasing a second report on healthcare quality in January or February. IOM committee member and Harvard professor Lucian Leape, M.D., says the new report will "call for an overhaul of the healthcare system and how to do it." The new document will be broader than the IOM's 1999 report on medical errors, which estimated that as many as 98,000 people die in hospitals each year as a result of medical errors.
* The Leapfrog Group, a consortium of 60 employers providing health benefits for more than 20 million Americans, initiated a plan in November to purchase healthcare from providers that meet their specific quality expectations.
* The Joint Commission on Accreditation of Healthcare Organizations is expected to implement its first set of standards dealing directly with patient safety in hospitals in July.
* HCFA's first national Medicare quality-of-care study released in October ranked states from best to worst and brought attention to the tremendous variation among providers in adhering to clinical best practices.
* The patient safety budget for the Agency for Healthcare Research and Quality -- the federal government's agency for patient safety research -- is expected to jump to as high as $50 million in 2001 from $4 million in 2000.
* A consumer study released in December shows that Americans are beginning to place more importance on standardized quality measures in selecting healthcare providers.
The energy around quality issues represents nothing less than a ground swell that healthcare providers will be forced to reckon with in the coming year.
The situation represents a dilemma for health system chief executives, some of whom confide that revamping their organizations to make substantial improvements in quality of care requires resources and energy already soaked up by a plateful of competing priorities.
Also complicating efforts to improve -- or even maintain -- quality of care is that we are in the midst of a nursing shortage which, unlike previous staffing crunches, has no end in sight. Fewer people are entering the nursing profession, the average age of nurses in the field continues to climb and all this is occurring on the brink of increased demand for healthcare services from the aging baby boomer population.
In the next year, California will complete regulations to guide implementation of mandatory nurse-to-patient staffing ratios in hospitals. Nursing groups say the ratios will increase supply by making nurses want to stay in the field; California hospitals worry that they will end up closing units if they can't find staff. In December, Leape hinted that nurse-to-patient staffing ratios might be good medicine for the country as a whole.