ASQ Healthcare Division Newsletter

September / October 2009

Visit the Heathcare Division Web site at www.asq.org/health

How to Pay for Healthcare Reform:
Improving Safety and Quality in Healthcare Delivery

In
an era when Congress and American consumers are rightfully indignant
and committed to solving problems with lead in toys, unhealthy
substances in food products, and the economy, we find that medical
errors and losses due to infections do not generate similar demands for
improvement. Have the medical profession, insurance companies, the
consumer, and Congress determined that medical errors and waste are
facts of life that cannot be addressed and solved?

Consider
medical errors and waste that people don’t like but don’t believe can
be corrected: hospital acquired infections, falls, medication errors,
pneumonia caused by ventilators, urinary infections caused by
catheters, and surgical errors including wrong-site surgeries and
foreign objects left inside the body.

These
errors and waste cause tens of thousands of deaths each year, and they
are extremely costly. According to a study by the Institute of
Medicine, the effects of medical errors result in tens of thousands of
deaths each year and cost between $17 billion and $29 billion. With a
widespread quality program, the results could make a significant
contribution to healthcare reform, lower premiums, and ensure a
healthier America.

As Paul O’Neill, former
Secretary of the Treasury, pointed out during a speech in Pittsburgh,
“Doctors and administrators already know how to do it. It requires
scrupulous adherence to simple but profoundly important practices like
hand-washing, proper preparation of surgical sites, and assiduous care
and maintenance of central lines and urinary catheters.” In the same
speech he stated, “…these improvements in patient care don’t cost
money, they save money.”

Jim Hall, former
chairman of the National Transportation Safety Board states to ASQ,
“Because American medicine accepts error as inevitable consequences of
treatment, our hospitals, insurers, and government do little to respond
to unnecessary deaths. If we are to address the problem in a serious
manner, we must first change the culture.”

Mr.
Hall correlates these issues with those he dealt with at the National
Transportation Safety Board. He reports, “After any significant
accident, the Board undertakes an extensive investigation followed by
recommendations to ensure that this or a similar accident never happens
again.” He argues that such an unbiased, credible organization can
substantially improve the safety of medicine in the United States. By
investigating well-known errors and infections, he believes the body
could determine causes, develop preventive measures, and make
recommendations to state and federal regulators, hospitals, and
healthcare officials.

Mr. O’Neill made a
similar suggestion when he said, “A next step would be for the
government to finance a prompt, detailed, and hard-headed study of
every example of error, infection, and other waste in five major
medical centers. Such data would give policymakers and caregivers a
clearer picture of the possibilities for cost-saving improvements.” He
also recommended training senior leaders, the workforce in hospitals,
medical students, the media, Congress, and the public in order to
“improve the level of the reform debates…and push for change…”

As
mentioned elsewhere in this newsletter, ASQ members know how to address
errors and waste by identifying  problems, determining root causes,
investigating sources and quantities of waste, and applying the right
performance improvement tools to eliminate the causes of death,
suffering, and cost. Let’s commit ourselves to being a part of the
solution, at the national, state, and individual entity levels.

Which
of the congressional proposals will capture even a fraction of the
roughly $1 trillion of annual waste that is associated with healthcare
process failures? Accept the IOM number that over 98,000 people die
from healthcare preventable problems each year and do the math that is
the equivalent of 435 fully loaded 737s crashing each year (one for
each congressional district) and 100 fully loaded 767s (one for each
senator). If that were to happen, I bet that would change the
healthcare debate in Washington.

Glenn Bodinson
Editor, ASQ Healthcare Division
glenn@baldrige-coach.com

Message from the Chair

I
hope this newsletter finds all of you well and watching with interest
the discussions around healthcare reform. We are doing so on our end
and are beginning to make some impacts in the discussion.

Activity About the Hill
Watch
for a special communication coming to you from the Division regarding
an opportunity for each of you to connect with your Congressperson
around healthcare reform. And, read Joe Fortuna’s report, “Dateline
Washington,” in this issue of the newsletter.

New Joint SHS/HCD Conference: “Building Better Delivery Systems”
We
have had an astonishing 177 abstract submissions for this new,
multi-disciplinary and breakthrough conference on healthcare. They all
are of excellent quality, and some are simply stunning. Planning
committee members are busy reviewing this exceptional body of work,
working hard to stay on a strict time line. Stay tuned for more news as
the reviews move towards completion and announcements. Other designated
members of both organizations are in the midst of organizing the
workshops and keynote speakers. I send our thanks to our colleagues at
SHS whose well-oiled conference planning skills and staff were utilized
in this first of three joint conferences. This is a conference you will
NOT want to miss—and tell all of your colleagues with an interest in
improving the way healthcare is delivered about it.

Web Cast Series: “No Wait EDs – This Is How We Do It”
The
work involved with the new joint conference has required that this
exciting series take a back seat for a few weeks. However, as we move
away from the review and announcement phases of the joint conference,
we will move towards organizing what should be a very
thought-provoking, even eye-opening, series of web casts. The intent is
to allow some real thought leaders to introduce us to the ED care
delivery models they have created and give the audience some insights
into how they crafted what they have created. The target audience is
not just people interested in the way Emergency Departments are run.
The intent is to foster an entirely new way of thinking about how
healthcare can be delivered anywhere and everywhere in a health system.

A Quote from Peter Pronovost, MD

The
fundamental problem with the quality of American medicine is that we’ve
failed to view delivery of healthcare as a science. The tasks of
medical science fall into three buckets. One is understanding disease
biology. Another is finding effective therapies. And the third is
ensuring those therapies are delivered effectively. That third bucket
has been almost totally ignored by research funders, government, and
academia. It’s viewed as the art of medicine. That’s a mistake, a huge
mistake. And from a taxpayer’s perspective it’s outrageous.”*

What is YOUR Passion?

* In A. Gawande. (2007, December 10). The checklist. The New Yorker, 9–10.

Dateline Washington
by Joe Fortuna, MD
Chair-Elect,  ASQ Healthcare Division

ASQ
and the Healthcare Division (HCD) are not just observers in this grand
and extremely important social experiment in Washington, DC, called
healthcare reform. The HCD wrote a white paper on healthcare reform,
which can be found on the HCD website at http://www.asq.org/health/index.html.

Healthcare reformers need to answer some simple questions that every ASQer asks in approaching a problem:

1. What are the problems?
2. What are the root causes of the problems?
3. How much and what types of wastes are involved?
4. What process improvement tools can/should be used to deal with the root causes and/or waste?

ASQ
also believes that healthcare reform legislation must incent the use of
process improvement and culture change tools at all levels of
healthcare.

Currently there are several events and programs intended to impact the healthcare reform debate and/or spread our messages:

1. On
   Sept. 15 at the Rayburn House Building, ASQ and the 21st Century
   Healthcare Caucus will jointly sponsor a two-hour seminar on “Getting
   Ready For Health IT: Preparation Is Everything!”
2. On
   Sept. 17, ASQ will present a national webinar for NBCH on the ASQ
   Marshall Plan for all 60 of the constituent NBCH regional coalitions.
3. ASQ
   is currently fine-tuning 11 joint project opportunities with HIMSS
   including a national call for case studies of excellence in quality and
   patient safety, authoring e-seminars on quality, process improvement,
   and change management in healthcare, and authoring a workshop on
   process improvement in health IT for the HIMSS 10 conference in Feb.
   2010.
4. ASQ is working with the HCD
   to publish a compendium of 40+ case studies of the successful use of PI
   in healthcare. This will be used on the Hill during testimony and will
   be made available to all HCDers free of charge.

Healthcare
reform and Health IT Initiatives provide an unprecedented opportunity
for ASQ’s HCD to provide real value in shaping the future of
healthcare. We are doing whatever we can to seize the moment and
capitalize on that opportunity!

Please let us know how and where you think we can do more and how you would like to contribute!!