August 5, 2011
Since 1999, when a national panel of experts released a landmark report on the high number of medical errors, insurers, policy makers and regulatory groups have been piling onto the quality-improvement wagon with ever increasing gusto. As a result of their enthusiastic efforts, hospital accreditation procedures and standards have become more rigorous, physician duty hours have been trimmed, hand-sanitizing gel dispensers in hospitals have multiplied and physician reimbursement has been linked increasingly with quality goals and less with the number of CT scans ordered.
But few of these quality enthusiasts are actually caring for patients. And when a study in The New England Journal of Medicine last fall reported that despite all the efforts and new financial incentives, there was no significant decrease in patient injuries, these same enthusiasts were quick to point to the inertia and intractable attitudes of the medical “culture.” They noted that less than 2 percent of hospitals had installed comprehensive electronic medical records systems, doctors and nurses were routinely working in excess of limits on duty hours and few were paying attention to even simple hand-washing recommendations. It would take nothing short of an all-out legislative, financial and regulatory assault to change the system, many of them concluded.
But what these “experts” failed to take into account was the same thing that has led to the downfall of countless other groups’ efforts to create sustainable change: They ignored the contributions of the people within the system.
There have been a handful of grassroots endeavors, but most have focused on specific clinical dilemmas. Now that may be changing. Last week, nearly 1,000 surgeons, nurses and hospital administrators from across the country convened in Boston to discuss what is quickly becoming one of the most far-reaching of such efforts, the National Surgical Quality Improvement Program from the American College of Surgeons, the largest professional organization of surgeons. With the average American undergoing nine operations in his or her lifetime, the implications of a program that can improve how patients do after surgery are enormous.
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