Here are two areas where the evidence is good that there's no question we should do it: disinfecting your hands and requiring people to have immunization against influenza. But we have no mechanism for making that happen. If a hospital doesn't require it, nothing happens and that's not right. It should be illegal.
HLM: Please elaborate about the lack of government support or leadership.
LL: Congress did appropriate $50 million a year for patient safety research, and that was a big shot in the arm. There were 99 new projects. But then Congress in its wisdom decided that money should be spent entirely on information technology, on computers.
So that's what happened, and that just pulled the rug out from under all this research. The agency that supports this research is the Agency for Healthcare Research and Quality, and they've never been well supported. It gets about $300 million for reporting, training and research. It should get at least $1 billion.
The National Institutes of Health gets $30 billion devising new treatments. And we spend $300 million assessing whether the treatments work. It's an incredible imbalance. There ought to be a National Institute of Quality Measurement to deal with this but there isn't.
With the Affordable Care Act, Congress created the Patient Centered Outcomes Research Institute, which is well funded, to develop evidence for effectiveness, but Congress has passed restrictions, so this area has not had the kind of national support, and it certainly doesn't look like it will in the near future.
HLM: Do you think that part of the problem has to do with skill levels and training? That providers don't have the necessary skills to be safer?