Visit the Heathcare Division Web site at www.asq.org/health

How to Pay for Healthcare Reform:
Improving Safety and Quality in Healthcare Delivery

In an era when Congress and American consumers are rightfully indignant and committed to solving problems with lead in toys, unhealthy substances in food products, and the economy, we find that medical errors and losses due to infections do not generate similar demands for improvement. Have the medical profession, insurance companies, the consumer, and Congress determined that medical errors and waste are facts of life that cannot be addressed and solved?

Consider medical errors and waste that people don’t like but don’t believe can be corrected: hospital acquired infections, falls, medication errors, pneumonia caused by ventilators, urinary infections caused by catheters, and surgical errors including wrong-site surgeries and foreign objects left inside the body.

These errors and waste cause tens of thousands of deaths each year, and they are extremely costly. According to a study by the Institute of Medicine, the effects of medical errors result in tens of thousands of deaths each year and cost between $17 billion and $29 billion. With a widespread quality program, the results could make a significant contribution to healthcare reform, lower premiums, and ensure a healthier America.

As Paul O’Neill, former Secretary of the Treasury, pointed out during a speech in Pittsburgh, “Doctors and administrators already know how to do it. It requires scrupulous adherence to simple but profoundly important practices like hand-washing, proper preparation of surgical sites, and assiduous care and maintenance of central lines and urinary catheters.” In the same speech he stated, “…these improvements in patient care don’t cost money, they save money.”

Jim Hall, former chairman of the National Transportation Safety Board states to ASQ, “Because American medicine accepts error as inevitable consequences of treatment, our hospitals, insurers, and government do little to respond to unnecessary deaths. If we are to address the problem in a serious manner, we must first change the culture.”

Mr. Hall correlates these issues with those he dealt with at the National Transportation Safety Board. He reports, “After any significant accident, the Board undertakes an extensive investigation followed by recommendations to ensure that this or a similar accident never happens again.” He argues that such an unbiased, credible organization can substantially improve the safety of medicine in the United States. By investigating well-known errors and infections, he believes the body could determine causes, develop preventive measures, and make recommendations to state and federal regulators, hospitals, and healthcare officials.

Mr. O’Neill made a similar suggestion when he said, “A next step would be for the government to finance a prompt, detailed, and hard-headed study of every example of error, infection, and other waste in five major medical centers. Such data would give policymakers and caregivers a clearer picture of the possibilities for cost-saving improvements.” He also recommended training senior leaders, the workforce in hospitals, medical students, the media, Congress, and the public in order to “improve the level of the reform debates…and push for change…”

As mentioned elsewhere in this newsletter, ASQ members know how to address errors and waste by identifying  problems, determining root causes, investigating sources and quantities of waste, and applying the right performance improvement tools to eliminate the causes of death, suffering, and cost. Let’s commit ourselves to being a part of the solution, at the national, state, and individual entity levels.

Which of the congressional proposals will capture even a fraction of the roughly $1 trillion of annual waste that is associated with healthcare process failures? Accept the IOM number that over 98,000 people die from healthcare preventable problems each year and do the math that is the equivalent of 435 fully loaded 737s crashing each year (one for each congressional district) and 100 fully loaded 767s (one for each senator). If that were to happen, I bet that would change the healthcare debate in Washington.

Glenn Bodinson
Editor, ASQ Healthcare Division
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Message from the Chair

I hope this newsletter finds all of you well and watching with interest the discussions around healthcare reform. We are doing so on our end and are beginning to make some impacts in the discussion.

Activity About the Hill
Watch for a special communication coming to you from the Division regarding an opportunity for each of you to connect with your Congressperson around healthcare reform. And, read Joe Fortuna’s report, “Dateline Washington,” in this issue of the newsletter.

New Joint SHS/HCD Conference: “Building Better Delivery Systems”
We have had an astonishing 177 abstract submissions for this new, multi-disciplinary and breakthrough conference on healthcare. They all are of excellent quality, and some are simply stunning. Planning committee members are busy reviewing this exceptional body of work, working hard to stay on a strict time line. Stay tuned for more news as the reviews move towards completion and announcements. Other designated members of both organizations are in the midst of organizing the workshops and keynote speakers. I send our thanks to our colleagues at SHS whose well-oiled conference planning skills and staff were utilized in this first of three joint conferences. This is a conference you will NOT want to miss—and tell all of your colleagues with an interest in improving the way healthcare is delivered about it.

Web Cast Series: “No Wait EDs – This Is How We Do It”
The work involved with the new joint conference has required that this exciting series take a back seat for a few weeks. However, as we move away from the review and announcement phases of the joint conference, we will move towards organizing what should be a very thought-provoking, even eye-opening, series of web casts. The intent is to allow some real thought leaders to introduce us to the ED care delivery models they have created and give the audience some insights into how they crafted what they have created. The target audience is not just people interested in the way Emergency Departments are run. The intent is to foster an entirely new way of thinking about how healthcare can be delivered anywhere and everywhere in a health system.

A Quote from Peter Pronovost, MD

The fundamental problem with the quality of American medicine is that we’ve failed to view delivery of healthcare as a science. The tasks of medical science fall into three buckets. One is understanding disease biology. Another is finding effective therapies. And the third is ensuring those therapies are delivered effectively. That third bucket has been almost totally ignored by research funders, government, and academia. It’s viewed as the art of medicine. That’s a mistake, a huge mistake. And from a taxpayer’s perspective it’s outrageous.”*

What is YOUR Passion?

* In A. Gawande. (2007, December 10). The checklist. The New Yorker, 9–10.

Dateline Washington
by Joe Fortuna, MD
Chair-Elect,  ASQ Healthcare Division

ASQ and the Healthcare Division (HCD) are not just observers in this grand and extremely important social experiment in Washington, DC, called healthcare reform. The HCD wrote a white paper on healthcare reform, which can be found on the HCD website at http://www.asq.org/health/index.html.

Healthcare reformers need to answer some simple questions that every ASQer asks in approaching a problem:

1. What are the problems?
2. What are the root causes of the problems?
3. How much and what types of wastes are involved?
4. What process improvement tools can/should be used to deal with the root causes and/or waste?
   

ASQ also believes that healthcare reform legislation must incent the use of process improvement and culture change tools at all levels of healthcare.

Currently there are several events and programs intended to impact the healthcare reform debate and/or spread our messages:

1. On Sept. 15 at the Rayburn House Building, ASQ and the 21st Century Healthcare Caucus will jointly sponsor a two-hour seminar on “Getting Ready For Health IT: Preparation Is Everything!”
2. On Sept. 17, ASQ will present a national webinar for NBCH on the ASQ Marshall Plan for all 60 of the constituent NBCH regional coalitions.
3. ASQ is currently fine-tuning 11 joint project opportunities with HIMSS including a national call for case studies of excellence in quality and patient safety, authoring e-seminars on quality, process improvement, and change management in healthcare, and authoring a workshop on process improvement in health IT for the HIMSS 10 conference in Feb. 2010.
4. ASQ is working with the HCD to publish a compendium of 40+ case studies of the successful use of PI in healthcare. This will be used on the Hill during testimony and will be made available to all HCDers free of charge.
   

Healthcare reform and Health IT Initiatives provide an unprecedented opportunity for ASQ’s HCD to provide real value in shaping the future of healthcare. We are doing whatever we can to seize the moment and capitalize on that opportunity!