Editor’s Notebook: Are We There Yet?
September / October 2012
When I hear the question, “How much improvement, if any, have we made to the safety and quality of healthcare?” I’m reminded of hearing a chorus of “Are we there yet?” from restless youngsters riding in the back seat. It’s an important question and not as easy to answer in healthcare than in the context of a family outing.
The question came up in 2009, at the 10-year anniversary of the Institute of Medicine (IOM) report, To Err Is Human, when prominent experts in quality and safety were asked to assess the movement’s progress. Many experts quoted in the media were carefully measured in their responses, usually saying something along the lines of, “Yes, we’re improving but not fast enough.”
UCSF hospitalist and safety expert Bob Wachter recast the question, asking, “What have we actually accomplished?” In thoughtful reflections on his blog and in Health Affairs (January 2010), his assessment was an “overall grade of B-, a slight increase from the C+ I awarded 5 years ago.” He also reflected on the question itself:
Many people will look at the past 10 years and wonder whether we’ve accomplished much of anything. I sympathize with this concern, one that’s partly driven by our maddeningly limited ability to measure progress in safety. Yet as I wander around my own medical center, signs of progress are unmistakable.
The question comes up again now in response to publication of the IOM’s report, Best Care at Lower Cost: The Path to Continuously Learning Health Care in America. Journalist, author, and blogger Paul Raeburn finds the report lacking in news value. He is frustrated by inefficiencies and dysfunctions that are obvious to patients—including himself—and which have been the subject of study after study. Blogging for the Knight Science JournalismTracker, Raeburn comments
The authors undermine themselves by noting that their report “builds on landmark IOM reports [including To Err Is Human]… If those reports were such landmarks, why didn’t they do anything to improve the healthcare system? …I would have appreciated a story [in the news media] calling out the Institute of Medicine for letting us know, at considerable expense, what any of us can find out when we get sick.
Both Wachter and Raeburn are right. Despite tremendous learning in the past 20 years about improving the process of delivering healthcare, we still have trouble quantifying the problem, measuring improvement, and delivering results, and it is beyond maddening that patients and their families—all of us—continue to suffer from poor performance in dimensions of quality the IOM identified 11 years ago as the way healthcare should be: safe, effective, patient-centered, timely, efficient, and equitable (The Quality Chasm, 2001).
On the other hand, the Agency for Healthcare Research and Quality has just announced that the national implementation of CUSP, Dr. Peter Pronovost’s approach to preventing central-line infections, has resulted in 40% reduction of these infections across 1,100 hospitals. Despite this great news and other successful projects in patient safety, we’re still not “there” yet.
For more on Best Care at Lower Cost and CUSP, see pages 8 and 9, and to join the conversation, contribute a comment to this article online. The online version of this column also includes live links for articles and reports mentioned above.