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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