Six months into an 18-month campaign to prevent 100,000 lives from being lost to adverse medical events, Institute for Healthcare Improvement President Donald Berwick, M.D., told physicians attending the American Medical Association's annual House of Delegates meeting in Chicago that a healthcare "quality chasm" still exists but local improvement efforts are helping to narrow the gap.
"All improvement is change, but not all change is improvement," Berwick said while citing examples illustrating how the chasm between the healthcare system's existing and potential quality remains quite wide. The most dramatic of these was how race is more significant than smoking status in determining a person's longevity.
The IHI's "100,000 Lives" campaign was launched last December with the goal of preventing 100,000 deaths using six interventions: rapid response teams who would respond to the first sign of patient decline, evidence-based care to prevent death from heart attack, medication monitoring to prevent adverse drug events, and taking steps to prevent central-line infections, surgical-site infections and ventilator-associated pneumonia.
"We're a rather dangerous industry," Berwick said, adding that the problems come from bad systems -- not bad people -- and that, no matter how careful, human beings will make mistakes. "Smart industries build dikes around human frailty."
The original goal was to enroll 2,000 hospitals in the campaign, but Berwick said more than 2,200 have signed on and that North Carolina and Washington were one hospital away from achieving 100% participation.
Berwick also noted that individual hospitals using IHI-endorsed interventions are reporting significant and measurable improvement. As an example, he cited the success of Baptist Memorial Hospital-DeSoto in Southaven, Miss., where rates for ventilator-associated pneumonia have dropped 46% in the past year.
Berwick cited AMA President John Nelson, M.D.'s early support of the campaign as "catalytic" to its success, while the AMA heaped praise -- and a presidential citation award -- on Berwick.
In introducing him, AMA Speaker of the House of Delegates Nancy Nielsen, M.D., said Berwick "is a hero to us on the American Medical Association board of trustees."
In response, Berwick quipped "It's not a good idea to render a speaker speechless before he's supposed to speak."
After his presentation, Berwick did hear some mild criticism from the audience about the campaign.
One physician noted that the campaign's interventions are all hospital-based, but the vast majority of healthcare services are received in outpatient settings. Berwick acknowledged the criticism but said change had to start somewhere and that one of the goals of the campaign was to build a "reusable national infrastructure" or network of change-minded individuals. If this network gets created, he said, it could be used for an ambulatory-care campaign.
Pittsburgh-based anesthesiologist Carol Rose, M.D., also criticized how people talk about "killing" patients and said she believed physician resistance to patient-safety efforts might be lessened if a different word was used. Berwick said change will come from local efforts and encouraged the audience to use language that would best help motivate local improvements.
To learn more about the "100,000 Lives" campaign, visit ihi.org.