“I believe the stakes are starting to get higher because our public stakeholders are starting to get impatient,” Chassin said. The reason for their impatience is that the once commonly shared faith in the U.S. healthcare system to consistently produce high-quality care “has pretty much evaporated,” he said.
Chassin himself is at least partly responsible for that change in perception. The former chairman of the Health Policy Department at New York's Mount Sinai School of Medicine served on the Institute of Medicine's Committee on Quality of Health Care in America that a decade ago produced the seminal report To Err is Human. Perhaps more than any other criticism, that work punched holes in the popular notion that quality in the U.S. healthcare system is a given. To the contrary, the totemic IOM report concluded medical errors were such common occurrences, they produce a multibillion-dollar plague of serious injuries each year, including tens of thousands of preventable deaths.
Despite hospitals and other healthcare providers having made “a huge effort in the last 10 years to improve safety and quality,” the U.S. still has a system that continues to allow the occurrence of serious preventable complications, the underuse of effective care and the overuse of treatments that increase patient risk while affording little in the way of tangible health benefits, Chassin said. So today, “public stakeholders are demanding excellence from the healthcare delivery system in unprecedented ways,” he said.
Chassin also warned that a growing movement to automate medical records may adversely affect the ability of providers and researchers to measure quality. On the up side, automation can reduce the burden of quality reporting and increase data accuracy, but, he said, “what is critically important is the clinical integrity of measures. We must not compromise the integrity of measures moving from abstracted data to automatically gathered data.”
There are some data elements, he said, “that likely will require abstraction for some time.” Thus, providers won't be able to eliminate abstraction any time soon, “nor should that be our aim.”
Since the Joint Commission pioneered the gathering and public reporting of quality measures in 2000, the American Hospital Association and the CMS have added quality-improvement programs of their own, Chassin said, so that we now have “a great deal of real-world experience.” Many measures, such as reporting on the administration of antibiotic prophylaxis for surgical patients, “work very well,” he said. “But we also know there are measures that don't work and we have to replace those with better ones.”
Smoking cessation counseling, for example, doesn't really measure the quality or efficacy of the anti-smoking educational process, Chassin said, adding—to loud applause—“that's causing a lot of unnecessary work that we need to get rid of.”
But even if the Joint Commission dropped its requirement to gather information and report data on counseling smokers, the requirement “wouldn't go away because Medicare still requires their collection and submission to avoid a payment penalty,” Chassin said.
Chassin said the healthcare industry needs to look to, and copy from, other industries that have long since instituted quality- and process-improvement tools such as lean manufacturing and Six Sigma to improve their operations. Then, healthcare workers need to ask themselves a question, “Can we transform healthcare into one of the safest industries in the world?”
“I think we must accept this challenge and we can't do anything less than succeed,” Chassin said.
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