The slow pace of hospital quality improvement frustrates patient safety advocates.
ORLANDO – Hospital leaders must adopt safety and quality as primary business strategies, rather than regarding them as tertiary metrics that rank below finances and other stressors on the C suite's list of top priorities.
That's according to Derek Feeley, president and CEO of the Institute for Healthcare Improvement.
Speaking to reporters here this month at IHI's 31st National Forum, Feeley says there are moral and financial imperatives for making safety a priority.
"The thing that should be uppermost in every healthcare leaders' minds is safety," he says. "If we create high-quality, safe healthcare systems, they are much more likely to be thriving and financially viable than healthcare systems that are unsafe and delivering a quality of care that patients need or want."
Given the stressors of hospital operations, Feeley says it's not surprising that hospital leaders get sidetracked.
"It's the way the system works. The current environment is one of growing consolidation and (people) are trying to figure out how to make sense of these often-conflicting payment models," he says. "Some of it's also what the board of governance and senior executives value, and part of that is the financial vitality of the institution."
"I keep trying to bring them back to there's another way to think about this. Is it at least possible to conceive that we can make quick progress on safety as our business strategy?" he says.
In August, the World Health Organization issued a report that one-in-10 hospital patients in "high-income countries" suffer harm, and that half of those adverse events are preventable.
IHI President Emeritus and Senior Fellow Donald M. Berwick, MD, was asked by reporters to assess what progress the healthcare sector has made over the past 20 years since the Institute of Medicine's landmark 1999 To Err is Human report.
"I'd say it's a B+ on the project-level improvements," Berwick replied, citing notable reductions in infections, pressure ulcers, ventilator pneumonia and surgical complications.
"Place-by-place you can see pretty serious improvements once people decide to work on it," he says.
The problem, he says, is that safety improvements are missing on a system level and can vary greatly among healthcare providers, and within geographic areas.
"We're at the really the point now where it's time to get serious," Berwick says. "We now know we really don't need to have pressure ulcers. We really don't need to have surgical site infections. We know how to virtually eliminate them."
"The bad news is we're seeing surveys, and when you ask healthcare executives and senior teams to rank what's on their mind, whereas safety was pretty high up there, number one or two a few years ago, it's now five or six, and we're finding places backing away," he says.
Rick Pollack, president and CEO of the American Hospital Association, disagreed "categorically" with the IHI leaders, adding that the "focus on quality in the DNA of our own organizations."
He noted that, between 2014 and 2018, hospitals in the AHA's Hospital Improvement Innovation Network program saved $1.2 billion in health care costs, prevented 141,000 patient safety events and saved 14,000 lives.
"To coin a phrase, quality is job one. If you're not providing the highest quality possible, then you're not serving your mission," Pollack told HealthLeaders. "The reality is that what you often see is people will rather shut down the service completely in order to provide the highest quality and services that they do provide.
That commitment to quality and safety metrics plays out in executive compensation.
"We see more performance-based compensation linked to quality Improvement than we ever have the past," he said.
Feeley said quality and safety are being address, but not quickly enough.
"It's not that we haven't made progress, but 20 years on, this ought to be the norm," he says. "We should have already moved on from patient safety being something we do and our project being a way (to do it), but it's not yet embedded. It still requires constant attention and maybe it always will."
"That's why I'm feel so passionately about this, as I see the risk of that diversion of attention and energy. It's right that we remind people that what started 20 years ago in earnest has made some progress but there's still so much to do," he says.
“When you ask healthcare executives and senior teams to rank what's on their mind, whereas safety was pretty high up there, number one or two a few years ago, it's now five or six, and we're finding places backing away.”
Donald M. Berwick, MD, President Emeritus and Senior Fellow, IHI
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.
Photo credit: Susan Young / IHI
IHI CEO and President Derek Feeley says there are moral and financial imperatives for making safety a priority.
IHI Senior Fellow and President Emeritus Donald M. Berwick, MD, says he fears that hospital leaders are not prioritizing patient safety.