Much work ahead on improving health care quality and safety

May 1, 2011

Ascension Health reports success in its quality care initiative

By INDU SPUGNARDI

WASHINGTON — While safety and quality initiatives are evolving and becoming more sophisticated in the U.S., progress has been slow. That was the thrust of an April 7 briefing by Health Affairs, a leading journal of health policy, and the Robert Wood Johnson Foundation.

Much more remains to be done to meet goals set out by the Institute of Medicine to ensure that all patients in this country consistently receive high-quality care, presenters at the briefing said.

The IOM put patient safety and quality on the radar of policy makers, providers and the public with two landmark reports on hospital care in the U.S. "Crossing the Quality Chasm: A New Health System for the 21st Century" published in 2001 and "To Err Is Human: Building a Safer Health System" released in 1999 focused attention on the tens of thousands of Americans who die each year from preventable medical errors. The 1999 report estimated that avoidable medical errors contributed to 44,000 to 98,000 avoidable deaths at U.S. hospitals annually.

Ascension Health's quality initiative
St. Louis-based Ascension Health responded to the IOM's report by redoubling its quality improvement focus. The system reports results of its efforts to eliminate preventable deaths in the April edition of Health Affairs. Dr. David Pryor, Ascension Health's chief medical officer, is the lead author of the article, "The Quality 'Journey' At Ascension Health: How We've Prevented At Least 1,500 Avoidable Deaths a Year — And Aim To Do Even Better."

Ascension Health's quality improvement strategy is part of its "call to action," an initiative launched a decade ago to transform health care by providing "Healthcare That Works, Healthcare That Is Safe and Healthcare That Leaves No One Behind." The safety and quality components of that initiative focus on eight priority areas: reducing mortality; improving performance on the Joint Commission's national patient safety goals; preventing adverse drug events; avoiding birth trauma; reducing the incidence of pressure ulcers, falls and fall injuries, and hospital-acquired infections; and reducing perioperative complications during the hospital stay.

The strategy was built upon the earlier work of Ascension Health's Clinical Excellence Team, which defined the system's quality roles and responsibilities in terms of its mission and values, and the quality road map outlined in the IOM's Crossing the Quality Chasm report.

Ascension Health also defined a measurable, quantifiable goal for its efforts — to prevent 15 percent of deaths (excluding admissions for end-of-life care) each year by July 2008. This metric was based on two studies cited in the IOM reports that found that between 8 percent and 22 percent of hospital deaths each year in the U.S. were preventable. Ascension Health set a baseline of the number of deaths in its hospitals in 2004. Reducing this by 15 percent would save 900 lives each year.

By fiscal year 2010, Ascension Health had reduced preventable deaths by more than 1,500 people annually. The system also made significant progress on its other priority areas:

Compared to national averages, Ascension Health has achieved the following:

  • 25 percent lower mortality
  • 65 percent fewer birth traumas
  • 89 percent lower neonatal mortality rates
  • 94 percent lower in hospital-acquired pressure ulcers
  • 74 percent lower in ventilator-associated pneumonia
  • 43 percent lower in central-line blood stream infections

The role of mission
While the IOM reports played an important role in Ascension Health's efforts to evaluate and improve the quality of its clinical care, its mission as a Catholic health care organization was the main impetus for undertaking the bold, unprecedented initiative, Pryor said.

"As a Catholic health care provider whose mission is to provide holistic and reverent care — care based on respect and compassion — we felt we had no choice but to make every effort to provide the best care possible," he said. "If we didn't, we weren't living out our mission."

Ascension Health leadership also felt it was important to share its story with others. "We hope others will be able to learn from our success," Pryor said, "just as we have learned from others."

The system's complete embrace and understanding of its mission and its relationship to quality care was vital to the success of this initiative, observed Pryor. The mission gave leaders and staff the impetus to strive for ambitious goals despite many unknowns. For example, system and individual hospital leadership dedicated significant resources to the effort without the specific evidence that is typically required for such investments. They did so because it was the right thing to do, Pryor said.

The mission also helped strengthen Ascension Health's safety culture. Frontline caregivers and staff at individual hospitals volunteered time and effort to develop and pilot interventions for specific priority areas and helped build a robust learning infrastructure. Learning collaboratives, in-person meetings, webinars and other electronic communications facilitated the roll out of proven interventions across all hospitals.

Most importantly, Pryor noted, was each hospital's commitment to transparency, which allowed each facility to share its performance on each action priority across the system.


Public and private voices clamor for quality improvement

The Patient Protection and Affordable Care Act provides many opportunities to help providers move forward with their quality improvement efforts, including:

  • The Partnership for Patients initiative, a $1 billion collaborative patient-safety initiative focused on reducing preventable harm and easing transitions of care.
  • The National Quality Strategy, which will serve as a tool to help coordinate quality initiatives between public and private partners as well as to leverage and coordinate existing efforts by federal agencies and departments to improve patient care.
  • New rules and payment reforms intended to help doctors, hospitals and other providers better coordinate care for Medicare patients through accountable care organizations.
  • Payment reforms that will link a portion of Medicare payments to whether hospitals are delivering safer care, using information technology effectively and meeting patient needs. Payment incentives and supports to improve quality and lower costs also will be available to state Medicaid programs.

"With new tools provided by the Affordable Care Act, we can aggressively implement programs that will help hospitals reduce preventable errors," Dr. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services, said in a news release. "We will provide hospitals with incentives to improve the quality of health care, and provide real assistance to medical professionals and hospitals to support their efforts to reduce harm."

Berwick is a keynote speaker at the 2011 Catholic Health Assembly in Atlanta.

The pressure on health care providers to improve quality is not just coming from public policy makers. Private payers and the public also are demanding better quality. A recent poll commissioned by the Robert Wood Johnson Foundation found that more than half of Americans believe the quality of U.S. health care is average at best. On a typical report card scale, 55 percent gave health care quality a C or D grade, and 11 percent gave the quality of care an F.

"The poll is a wake-up call for payers and the health care industry, both of which have been working steadily to improve the quality of care, but need to kick their efforts into overdrive toward accountability," said Dr. Risa Lavizzo-Mourey, president and chief executive of the Robert Wood Johnson Foundation.

— Indu Spugnardi

 

Copyright © 2011 by the Catholic Health Association of the United States
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