A host of challenges-from costs to inertia to data-measurement problems-continues to plague the healthcare industry's efforts to improve safety and quality, according to speakers at a conference held last week to mark the fifth anniversary of the Institute of Medicine's landmark report, To Err is Human.
While the consensus is that hospitals still fall far short of safety goals set by the 1999 IOM report that sent shudders through the provider community (Nov. 1, p. 6), much of the one-day colloquium sponsored by the Commonwealth Fund focused on the reasons for the shortcomings and how to rectify them.
Although awareness of safety and quality has been raised, potential solutions have been too small in scale and too slow in coming, speakers and audience members said.
"There are a lot of islands of hope," said Carol Haraden, vice president of the Institute for Healthcare Improvement, a not-for-profit Boston-based patient advocacy group. "The problem is that they're islands."
Lucian Leape, an adjunct professor of health policy at the Harvard School of Public Health and an IOM member who helped draft the 1999 report, said, "We don't have a national effort; what we do have is a national discussion" aimed at improving safety.
The IOM made a number of recommendations, such as establishing a Center for Quality and Patient Safety within the Agency for Healthcare Research and Quality, and setting performance standards and expectations. Those goals have been achieved to varying degrees, speakers said, and in 2003, the AHRQ released its first national reports on healthcare quality and on disparities as mandated by Congress.
Edward Kelley, director of the National Healthcare Quality Report by the AHRQ, said that since 1999, the healthcare industry has taken steps to improve safety. In an NHQR report that will be released next month, he said, data will show that some quality measures-such as inappropriate administration of medications and instances of foreign objects being left in patients during procedures-have shown improvement.
But Leape questioned the benefits of even having a national report on safety. More worthwhile, he said, would be comparative reports on how individual institutions are doing. Several such efforts already exist, including the CMS' hospital quality initiative.
David Brailer, HHS' national coordinator for healthcare information technology, said doctors' offices, as well as safety net and rural providers, are a major source of concern.
The government is still struggling to figure out how to help them with costs, how to help them identify appropriate IT systems and how to make those systems interoperable, he said.
"This is to me one of the big policy dilemmas," Brailer said. "What is the role of the federal government?"