When Mark Neaman first saw the 1999 Institute of Medicine report To Err is Human, he was horrified, he said. According to the report, as many as 98,000 Americans die each year from unnecessary medical errors, and like other hospital executives, Neaman, president and chief executive officer of Evanston (Ill.) Northwestern Healthcare, saw it as a wake-up call to make changes at his own facility.
So during the past two years, the three-hospital system in the Chicago suburbs has fully implemented an electronic medical record system, educated staff and launched an online portal where patients can have 24-hour access to their medical information and correspond with physicians.
The result has been a 20% drop in medication errors and total elimination of transcription errors, Neaman said.
But while patients have expressed gratitude at no longer being asked the same questions repeatedly, or are surprised when nurses are already aware of their drug allergies, other quality improvements go unnoticed.
"The patients do not understand medication errors," Neaman said. "They don't understand our processes, nor should they."
Five years after the groundbreaking IOM report, follow-up reports and assessments have painted a bleak picture of healthcare quality and safety. But according to providers, the perception doesn't quite fit the reality.
Just last week, the Leapfrog Group and the Kaiser Family Foundation released separate reports that reinforce the consensus that there remains a wide chasm between what has been done since the IOM report was released and what still needs to be done.
According to Leapfrog, a consortium of healthcare purchasers, despite a concerted effort, only 21% of hospitals have fully met the 27 quality measures endorsed by the National Quality Forum, including procedures to avoid wrong-site surgery and ensure safe medication use. And despite all the talk of information technology in healthcare, only 4.4% of the 1,019 hospitals surveyed have fully implemented computerized physician order-entry systems.
Out of 2,012 adults surveyed by Kaiser, the Agency for Healthcare Research and Quality, and the Harvard School of Public Health, 55% of respondents said they were dissatisfied with the quality of healthcare, up from 44% four years ago. Just 17% said healthcare had improved during the past four years and 48% said they are concerned about the safety of the medical care that they and their families receive.
According to Don Nielsen, senior vice president of quality leadership at the American Hospital Association, hospitals have ratcheted up their efforts to improve quality, despite consumers' inability to see immediate results.
"If you will, it's like a tsunami where you don't see the earthquake and the tidal wave that's happening beneath the surface of the sea. It's something that's not intuitively obvious, but a lot of action and energy is being devoted and I think that's what we're seeing occur with hospitals both in the area of safety and the area of quality," Nielsen said.
Indeed, many hospitals are investing heavily in quality initiatives. Evanston Northwestern, for example, has pumped $40 million so far into its efforts, Neaman said.
At St. Luke's Episcopal Hospital, a 664-bed facility in Houston, administrators reacted by creating a new position-director of patient safety and quality enhancement. Then they bar-coded medication and tried to improve doctors' handwriting to cut down on prescription errors.
"We actually did doctor-writing classes," said Margaret Reiter, St. Luke's quality director.
Eventually the hospital moved to a system where doctors input drug prescriptions by computer and computerized standard order sets so doctors could see what kinds of drugs were recommended for a specific ailment. St. Luke's has implemented all national patient-safety goals including those established by the NQF.
Despite such efforts, some said patients have good reason to have a dire view of healthcare. Arthur Levin, director of the Center for Medical Consumers, a not-for-profit advocacy group, doesn't dispute that hospitals have taken measures to improve quality and safety but said the efforts have been too discrete.
"I just don't think there's any evidence that (safety and quality) is any better now than it was five years ago," he said. "When you look at studies that try to quantify how bad things are, it's pretty bad."
He and others have said that what's missing is a genuine national effort by lawmakers.
But to Nielsen, the work of hospitals and providers as well as initiatives by the federal government constitute a national effort. "I think a national effort is under way in the sense that everyone has rededicated themselves to improving patient safety," Nielsen said.