But take a look anyway, if you have an interest in process improvement in hospitals. This is a collection of my best posts on this topic.

Thursday, February 12, 2009

Good and bad news about infection control

I have been writing for some time about our efforts to eliminate central line infections in our hospital, and we have been totally transparent about our progress in that regard. While I know you can always look these things up, I want to make it easier for you and give you some advance news -- especially in light of the most recent results.

During the first four months of this fiscal year, a period covering about 7000 patient days, we had only one CLI in our intensive care units. This represents a tremendous effort by dozens and dozens of staff people.

In early 2006, our hospital's rate of infections was about 2 per thousand ICU patient days. At that old rate, there would have been 14 infections during this same four-month period. Given a 12 to 25 percent mortality rate associated with such infections, 2 or 3 people would have died unnecessarily.

Do we need a better reason to engage in these programs?

Two years ago, I raised a question: "If I can post these rates for BIDMC, why can't people from other hospitals? ... I am seeking no competitive advantage here. This is an attempt to get past a culture of blame and litigation and persuade people that transparency works: Real-time public disclosure of key indicators like this ... can be mutually instructive and can help provide an incentive to all of us to do better."

Then, a short while ago, I asked the question in a more direct way, posing a challenge to all the Boston area hospitals to jointly engage in a program to eliminate these kinds of infections and share their progress with the public.

The response to my public and private entreaties in this realm has been silence -- from hospital professionals, from insurance executives who care about a transformation of this industry, and, indeed, from public advocacy groups who care about access to care and the quality of care delivered. Some observers attribute the medical profession's lack of engagement to an underlying fear of transparency. And yesterday, a world expert in this field, whose wisdom and advice I treasure, told me that he has come to accept gradual progress in quality and safety improvement, citing the kind of training doctors get, which does not emphasize these areas. That such a person has become content with gradual changes in the status quo is an indication of what it must be like to beat your head against this wall of recalcitrance for several decades.

My advantage, being without medical training and having had but a short tenure in this field, is that I retain a sense of outrage. Our collective failure to approach this problem using well established methods of process improvement -- including publication of current performance results -- represents a moral and ethical lapse by the clinical and administrative leadership of the medical establishment in this city. Why? Simply put, a profession that takes an oath to do no harm is, by inaction or incomplete action, doing harm. We are causing people to die who should not die. What would we call that if we saw it happening in other sectors of society?

Monday, February 9, 2009

How was your visit?

A couple of years ago, I wrote about our use of mystery shoppers to evaluate how well we provide service in our ambulatory clinics. (You can also read more about it in this Boston Globe story by Liz Kowalczyk.)

Now, we are going the next step, not only conducting surveys of patients about their experiences in our clinics, but posting the survey results in those very same clinics. A portion of the survey is shown above. You will see three particular questions highlighted (just here, not on the actual survey). Those are the ones about which we receive the most complaints.

You also see above a mock-up of the kind of poster that will be prominently displayed in each waiting room, showing the performance results of that clinic for all to see. We believe this is part of "putting ourselves under the microscope." We have aspirations, not only to have an incredibly safe hospital, but also to rank highest in patient satisfaction in the country. We believe that you cannot achieve aspirations like this unless you hold yourself accountable by being transparent with regard to your progress.

I'd love to get comments from others out there, whether in hospitals or other businesses, as to whether you have tried this and what you have learned from it.

P.S. The mystery shoppers are still at work. We never stop learning from them.