Transcript “How Do They Do That?” HRRs Price-adjusted per

The Status of Patient Safety
Donald M. Berwick, MD, President and CEO
Institute for Healthcare Improvement
10th Anniversary of To Err is Human
The Commonwealth Fund and Alliance for Health Reform
March 17, 2010: Washington, DC
Topics
1. Trends, Impact, and Gaps in Patient
Safety
2. Priorities for Closing the Gaps
3. Constructive Roles for the Federal
Government
4. A Vision for the 20th Anniversary of To Err
Is Human
2
Trends since 1999
• Firm documentation of widespread,
avoidable harm to patients.
• Better understanding of the “safety
science.”
• Better methods of detection and
measurement.
• Better appreciation of a “culture of
safety.”
• Breakthrough results in some
organizations.
3
Hospital Standardized Mortality
vs. Hospital Reimbursement
HSRR vs HSMR - Hospital Standardised Mortality Ratio vs Hospital
Standardised Reimbursement Ratio (2007 Medicare Data)
Hospital Standardised Mortality Ratio (HSMR 2007)
140
120
100
80
60
40
20
0
0
50
100
150
Hospital Standardised Reimbursement Ratio (HSRR 2007)
Source: Sir Brian Jarman 2009
200
250
Institute for Healthcare Improvement
Safety Campaigns
2004-2006
2006-2008
5
The Campaign “Planks” -Twelve Changes for Safety
1.
2.
3.
4.
5.
6.
6
Rapid Response Teams
Evidence-Based Care for Heart Attacks
Medication Reconciliation
Prevent Central Line Infections
Prevent Surgical Site Infections
Prevent Ventilator-Associated Pneumonias
The Campaign “Planks” -Twelve Changes for Safety
7. Prevent Pressure Ulcers
8. Reduce Methicillin-Resistant Staphylococcus
Aureus (MRSA) Infections
9. Prevent Harm from High-Alert Medications
10.Reduce Surgical Complications (the Surgical
Care Improvement Project (SCIP))
11.Evidence-Based Care for Congestive Heart
Failure
12.Get Boards on Board
7
8
Sentara Williamsburg (Virginia)
Zero Ventilator Pneumonias in Five Years!
9
Seton Family of Hospitals (Austin, TX)
Birth Trauma Prevention
One Birth Injury in 10,000 Deliveries
10
Pressure Ulcer
11
Error Reduction at Ascension
Preventable Error
Reduction in Rate
Pressure Ulcer
95%
Neonatal Mortality
79%
Birth Trauma
74%
Ventilator-Acquired Pneumonia
54%
Falls with Serious Injury
Bloodstream Infections
56%
32%
Palmetto Hospital Mortality Rates
(South Carolina)
13
Does Improving Safety Save Money?
HENRY FORD HEALTH SYSTEM
IMPROVEMENT
COST
SAVINGS
NET
SURGICAL
INFECTIONS
($110,000)
$540,000
$430,000
BLOODSTREAM
INFECTIONS
($22,500)
$4,780,000
$4,757,500
VENTILATOR
PNEUMONIAS
($1,268,500)
(Reduced Revenue)
$1,166,400
($102,100)
RAPID RESPONSE
TEAMS
($390,000)
?
($390,000)
TOTAL
($1,791,000)
$5,320,000
$4,695,400
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Closing Gaps – What Now?
•
•
•
•
•
Governance – Boards – responsible for safety
Better measurements of safety levels
More transparency
Science to devise standards that work
“National learning systems” to spread the
successes – Make “the best” become “the
norm”
• National stewardship – a “public health” model
• Consequences for inaction
15
How Government Can Help:
“Will, Ideas, and Execution”
16
GAP
GOVERNMENT
Boards responsible for safety
Map into accreditation standards
Better measurements of safety
levels
Support prompt, active research on
measurements of safety
More transparency
Further develop Medicare data,
measurement, and reporting capacity
Science to devise standards that
work
Support research on safety sciences and
health care process designs
“National learning systems” to
spread the successes
Develop public and private “extension”
capacities for knowledge management
National stewardship – a “public
health” model
Annual reports on quality and safety,
with Congressional and Executive review
Consequences for inaction
Unlink payment from volume; study “no
pay” for defects
“20th Anniversary Report”
• Injury Rates in American Hospitals Measured
and Tracked
• National and Regional “Learning Systems”
Spread Good Practices
• Safety Education Routine in Health
Professional Development
• Health Care Sets a Benchmark for HighHazard Industries
• Patient Injuries Reduced by 90% from 1999
• Health Worker Injuries Reduced by 90%
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The “Triple Aim”
Population
Health
Experience
of Care
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Per Capita
Cost
How Do They Do That?
High-Performing Communities in American Health Care
Everett, WA
La Crosse,
WI
Cedar
Rapids, IA
Portland, ME
Sayre,
PA
Richmond, VA
Asheville,
NC
Sacramento,
CA
Tallahassee,
FL
Temple, TX
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$10,250to 17,184
9,500 to < 10,250
8,750 to < 9,500
8,000 to < 8,750
6,039 to < 8,000
Not Populated
(55)
(69)
(64)
(53)
(65)
What Are They Doing?
Per-Capita Spending – and Spending Growth – Are Lower.
Price Adjusted
Spending
2006
Increase in
Spending
1992 – 2006
Annual growth
rate
All Others (232)
$9,695
$3,376
3.6%
Qualifying (74)
$8,212
$2,645
3.4%
Participants (10)
$7,924
$2,297
3.0%
Potential Annual Savings: 12.7% - 16.2%
20