A National Quality Strategy can create improve patient safety

Among the many provisions in the Patient Protection and Affordable Care Act are elements intended to assure that every American has access to healthcare that is patient-centered, affordable, and of the highest clinical quality.

In my mind, one of the act’s most essential goals is to establish a National Health Care Quality Strategy — one that integrates disparate federal and private sector initiatives, building on and expanding current quality assessment and improvement programs for hospitals and physicians.

How do we go about creating such a strategy?

On the plus side, we have a strong foundation of work led by federal, state, and private sector quality initiatives that have identified challenges and opportunities to improve our nation’s healthcare.

The difficult but vitally important part comes next — giving due consideration to all the different public and private organizations that are working independently on a variety of approaches to improving the quality and safety of healthcare, taking full advantage of this shared commitment and range of viewpoints.

Reporting requirements is another element that presents a challenge. Today, each agency and entity has its own set of reporting and accreditation requirements — a situation that results in hospitals and other institutions spending huge amounts of time and money developing reports for each agency.

Unfortunately, most of this work does not help the institutions identify their own priorities for increasing the quality and safety of the care they provide.

When the National Health Care Quality Strategy and Plan was announced in September, Health and Human Services (HHS) Secretary Kathleen Sebelius wisely encouraged feedback from all sectors.

Last month, my colleague, Susan DesHarnais, MPH, PhD, Program Director for Quality and Safety, and I sent our institution’s response to Secretary Sebelius. The gist of our message was that, in order to be effective, the national strategy must incorporate:

  • A certain degree of consolidation and reconciliation of the current performance data reporting requirements among various public and private agencies.
  • An effort to standardize adverse events reporting across states and across hospitals. Although not perfect, the system currently used in Pennsylvania is a good prototype.
  • A commitment to developing and designating risk-adjustment methods to be used for comparing various patient outcomes across hospitals to enable benchmarking and progress measurement over time. Because separate models are needed for different patient outcomes within each disease type, current methods are inadequate.

If we expect the quality and safety of healthcare to improve under the new strategy, we must recognize and address another strategic imperative: We can no longer afford to relegate professional performance, transparency, and accountability to ad hoc efforts.

The new strategy must include a call to action for leaders in medical education to take a strong, proactive role in promoting safer medical care.

Changing the culture of medicine will require appropriate patient safety education that begins early in medical education, continues throughout graduate training, and remains an integral part of continuing professional education throughout a physician’s career.

Many professional organizations already are moving in this direction.

For example, the Association of American Medical Colleges’ Integrating Quality Initiative, a performance improvement project, helps members manage their roles as educators while providing outstanding medical care.

And Open School, an ongoing initiative of the Institute for Healthcare Improvement, provides outstanding educational resources and networking opportunities that emphasize interdisciplinary healthcare team skills with real-world applicability.

Increasingly, universities are stepping up to the plate as well. I’m pleased to report that Thomas Jefferson University is among them.

We currently offer opportunities in patient safety training across the medical education continuum including: a specialized clerkship in patient safety for third year medical students, a lecture series on professionalism in medicine for advanced medical students, and a full-day regional Leadership Forum on Quality and Safety for resident physicians.

These types of activities are good, but they are just the beginning.

Intensive, interdisciplinary training in quality and safety improvement will be essential to improve teamwork and change the culture of all those who provide healthcare.

My hope is that the National Quality Strategy will be successful — especially when it comes to creating a culture of healthcare quality and patient safety among those of us practicing medicine today as well as for a new generation of professionals.

David B. Nash is Founding Dean of the Jefferson School of Population Health at Thomas Jefferson University and blogs at Nash on Health Policy.

Originally published in MedPage Today. Visit MedPageToday.com for more health policy news.

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  • doc99

    Call me jaded but when I see the word “Quality,” I hear “Cost.

  • http://www.bryantsstatisticalconsulting.com Donald Tex Bryant

    I concur with Dr. Nash’s assessment. Two points of his that I especially support are the consolidation of reporting on measures of quality required at the Federal and state level and the concept of team work.

    Because of the amount of reporting required by the various quality bodies at the Federal and state level there is serious distraction from the achievement of quality itself. Consolidation would allow quality teams more time and effort to improve quality at their site.

    I also concur that achieving quality is a team effort that includes not only physicians but also all other clinical staff. Further, quality outcomes should also include not just clinical outcomes, as many focus on, but also on outcomes such as patient satisfaction, which includes non-clinical staff and ultimately affects clinical patient outcomes via patient adherence to directions for their own care.


    In all of our readings at my office, my administrator and I have found that the importance, truth and relavance of an article are inversely proportional to the number of times the word “quality” appears in that article.

    “Quality quality quality quality…..”

    These “quality” rants are quite annoying but may prove to be a great drinking game similar to the “Bob” drinking game of the Bob Newhart Show era.

  • Marc Gorayeb, MD

    For the life of me, I don’t have a handle on what the author is talking about. This piece is a glittering example of bureaucratic gibberish. Providing a 30,000-foot overview when you’re trying to see the leaves on a tree. My eyes glazed over in record time.
    A few terms, however, caused me to perk up: reporting requirements, professionalism, interdisciplinary, change the culture, patient safety training across the medical education continuum.
    Allow me to translate (I’m only guessing, because after all it’s Greek to me): we’ll make you spend endless hours filling out forms, we’ll change your culture to suit our liking, we’ll diminish you as an individual and a professional by burying you in a ‘team,’ we the bureaucrats will make pronouncements – and indoctrinate you – on how to behave.
    You are witnessing the laying of a foundation for limitless make-work for bureaucrats.

  • Jack Lewin, MD

    The American College of Cardiology also recently submitted comments on the National Health Care Quality Strategy and Plan. The comments state ACC’s commendation of HHS for offering a venue for public participation in the process of identifying key issues for health care quality. Our response also stresses our commitment to quality and outlines what quality programming we currently offer, such as clinical documents, registries, patient education, D2B, Hospital to Home, etc. However, at the current stage, HHS’ strategy is non-specific and this is a serious limitation. Specifics will be needed to provide clarity about what programs and initiatives align with the plan and to hold everyone accountable for results. ACC’s letter is online.

    Jack Lewin, MD
    CEO, American College of Cardiology

  • gzuckier

    This is going to be one of those Pareto things, where 20% of providers are bad, 20% are great, and the rest are largely interchangable. Maybe even 10% or less at each end, rather than 20%. In a past life monitoring outcomes for a bunch of hospitals (at their request) it was exceedingly rare to find something that stood out from the pack enough that you’d bet your career on it. Obviously, individual variation between cases is so large as to obscure minor differences, even when case-mix adjusted ad nauseum. And fact is, the profession is self-policing to a degree you don’t see with plumbers. Or politicians. Or statisticians.

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