Berwick: Hospitals Are Still Aboard The Quality Train

At a time when survival is on the mind of every hospital executive, are healthcare leaders letting up on quality improvement? Not according to Donald Berwick, president of the Boston-based Institute for Healthcare Improvement, which has long led the charge for hospital quality and safety. He said that there’s a lot of enthusiasm among hospital execs for IHI’s “5 Million Lives” campaign, which has the support of about 4,000 facilities across the country. It’s also getting results: For example, pressure ulcer cases are down 70 percent in New Jersey; central line infections have dropped 40 percent in Rhode Island; and 65 participating hospitals across the country haven’t had a ventilator-associated pneumonia for over a year.

Speaking at a press conference at IHI’s 20th annual conference in Nashville, Berwick tied better quality of care to efficiencies that benefit hospitals’ bottom lines. “Quality improvement weds cost reduction with improvement of the patient experience. There are many changes that can be made that both improve patient experience and save money. That’s critical for hospitals right now.”

So IHI plans to offer its members a “CFO package” that shows them how to improve quality while reducing costs. At the same time, IHI wants to put a new “surgical checklist” from the World Health Organization in every U.S. hospital, starting with the hospitals involved in the 5 Million Lives campaign. Atul Gawande, a surgeon, author, and director of WHO’s Global Patient Safety Challenge, who helped develop the checklist, said at the press conference that Washington State was already rolling out the document to its hospitals with IHI’s help.

Gawande said that the time was propitious for this initiative, because hospitals are starting to realize that quality improvement can save money. “I’m seeing lots of departments of surgery that are freezing hiring and beginning to cut staff, because they’re afraid that an extra 1-2 percent of uninsured patients are going to sink them well before reform comes. So a lot of hospitals are looking for tools that let them improve their quality and manage their costs. Just firing people isn’t working. They have a huge backload of demand for care, and the CEOs know they have a huge amount of waste.”

Joseph McCannon, an IHI vice president, talked about working with hospitals on a “waste portfolio.” If a hospital committed to eliminating 1 to 3 percent of waste each year, it could reinvest the savings elsewhere in the organization, he said.

But the fact still remains that waste and the complications that a surgical checklist might prevent generate revenue for hospitals, and it’s advantageous for them not to keep some patients too long. In a recent report from the Center for American Progress, Berwick and co-author Chiquita Brooks-LaSure wrote, “Most health care providers, even large hospitals, still lack both the will and the competence to improve the processes of care, and most health care boards of senior executives and trustees view the improvement of care as a strategic agenda at best secondary to maintaining revenues and stabilizing public reputation.”

Asked about that statement in Nashville, Berwick responded, “It’s fair to say that the incentive structures in place now for hospitals focus much more attention on productivity and throughput—that’s where hospitals get their revenue.” But he said that payment reform could “make it far more plausible and interesting for hospitals to engage in the improvement of care directly—not just because it’s morally good and good for the patients they serve, but because they can do it practically, and it helps them as organizations, and it’s time for that change.”