STANFORD, Calif. — Despite concerted efforts, no decreases in patient harm were detected at 10 randomly selected North Carolina hospitals between 2002 and 2007, according to a new study from the Stanford University School of Medicine, Harvard Medical School and the Institute for Healthcare Improvement.
Since a 1999 Institute of Medicine report sounded the alarm about high medical error rates, most U.S. hospitals have changed their operations to keep patients safer. The researchers wanted to assess whether these patient-safety efforts reduced harm. They studied hospitals in North Carolina because that state has shown a particularly strong commitment to patient safety.
The US car makers had to improve safety because they were losing customers (lots of customers) to Japanese makers. Well, there's no Consumer Reports or J.D. Powers rating hospitals the way car makers are rated for quality. So the pressures to improve quality have got to be less intense. Can hospital error rates fall substantially? Can this be done with just internal bureaucratic pressure? Or with regulatory pressure? Or are market incentives needed? If so, what form of incentives?
Some best practices were still not being used in 2007. This NY Times article has good coverage.
The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.
Why did it take so long from 2007 to 2010 to publish the results? What's needed is a much shorter loop between a measured time and known results. In manufacturing settings the quality measurement results are often known the same day or in even less time.