A set of exit interviews were done at a group of large clinics several years ago asking patients why they had chosen to see the physician they had seen. The answers were tallied and then ranked. Can you guess where “quality” was on this ranking? Not in the top twenty! The greatest number of responses was “ease of parking!” For many, many years quality has been assumed in healthcare. But now we know that this assumption is faulty. In fact, when ranked among all industrialized nations by the World Health Organization, the US ranks #37!
In 2001 the Institute of Medicine (IOM), a part of the National Academies of Science and the most respected healthcare policy-making body in the country published a landmark study called “Crossing the Quality Chasm” stating just that – there exists a great chasm in quality in this country’s healthcare outcomes.
According to this report, every year over 98,000 Americans die in hospitals because of preventable medical errors. That report made the news for a couple of days and then seemed to be forgotten. But what would happen if a 747 airliner went down killing everyone on board every day for a year. That’s 98,000 deaths. The obvious question is “Are these bad people doing bad things?” The Institute of Medicine answered that clearly, stating:
“The problem is not bad people in health care–it is that good people are working in bad systems that need to be made safer.”
So what we have is a problem of bad “systems.” But even when we know what to do to improve the systems, we rarely do. The evidence is very clear – adoption of electronic health records improves quality and saves lives. But there is more technology being used in your local grocery market than in your typical doctor’s office.
The evidence is rock-solid – broadly immunizing patients young and old prevents crippling diseases and saves lives. Yet, less than 50% of our population is up to date on these life-saving immunizations. Preventing and controlling high blood pressure can save more lives than almost any other single act, and yet hypertension affects more and more Americans and less than a third of patients with this diagnosis are under control. Why?
The IOM says that there are six characteristics of quality care. See if you agree with the following:
Safe – any of us who encounter the healthcare system should have an unqualified expectation of safety; and yet, we know that preventable medical errors – medication errors, etc.- happen many times every day. A year ago I had the unfortunate opportunity to have been a “guest” of our system, having spent about 20 hours in the ICU. In that short time eleven medical errors occurred that could have had serious sequellae. Why shouldn’t care be safe?
Timely – this doesn’t mean that sometimes we shouldn’t have to wait a few minutes in the waiting room. It means that when we need care, we should get it in a timely manner. This is a real problem in some countries where patients wait for many months to have needed tests and procedures.
Effective – the care we get should be the “right” care. Unfortunately, according to researchers at RAND Health, the “right” thing only happens about 55% of the time.
Efficient – this means that we should get the “right” care, but ONLY the right care. Over many years most Americans have come to believe that more is better. But in healthcare, that is almost always wrong.
Equitable – all of us should have access to the same quality care.
Next time we’ll talk about “systems” of care, and why and how they work.
Courtesy of Dr. Michael Fleming, M.D. – member of the AdvoCare Scientific & Medical Advisory Board
Dr. Fleming – 6 Characteristics of Quality HealthCare
November 3, 2008 by advocare08