All Minnesota hospitals should make this same commitment to patient safety
There is good news and bad news when it comes to patient safety in hospitals. The good news: Since the Institute of Medicine, (IOM) released its report in 1999 that detailed the cause of 100,000 needless deaths in hospitals due to medical mistakes, hospitals have made improvements in public reporting of outcomes and implementing quality improvement practices. The bad news: We still have a long way to go and in some cases, we have lost ground.
One form of public reporting that occurs in Minnesota hospitals is the reporting of "never events." Never events are 27 things that should never happen when you’re in the hospital. The list includes things like surgery being performed on the wrong body part, death associated with contaminated drugs, an infant who is discharged to the wrong person, and patient falls. Never events are puplicly reported annually at the state level in a report from the Minnesota Department of Health as “adverse events.” While this information is critically important to improving the quality of care in hospitals, it takes a retrospective look at what has gone wrong. Although it’s important to learn from mistakes so they are never repeated, more information should be provided to individual health care consumers so they can understand what hospitals are doing right, based on what is important to them, as patients.
In 2000, the Leapfrog Group was established by health care purchasers in an effort to use available evidence to help real people understand what is actually being done by hospitals to prevent mistakes before they happen. With the assistance of purchaser organizations like the Buyers Health Care Action Group (BHCAG), Leapfrog conducts an annual survey of hospital patient safety procedures and outcomes, with a focus on what hospitals are doing right. Twelve hundred hospitals across the country complete the survey and their results can be found at www.leapfroggroup.org. Unlike other hospital quality and safety reports, the Leapfrog Group reports on processes and outcomes that matter to a broad spectrum of the general public and delivers that information in a way that real people can understand. Hospitals complete many different surveys each year, some required by regulatory bodies, some required by health plans, some required by accrediting agencies. However, the Leapfrog survey is the only purchaser developed and requested survey.
Minnesota hospitals have historically scored very well on the Leapfrog survey, and 2010 is no exception. This year, three Minnesota hospitals were recognized with the Leapfrog Group’s Top Hospital Award. Those hospitals are: Children’s Hospitals and Clinics-St. Paul, Children’s Hospitals and Clinics-Minneapolis, and Mayo Clinic Rochester-St. Mary’s. Less than 6 percent of all hospitals that report to Leapfrog receive Top Hospital status.
Children’s Hospitals and Mayo Clinic stand apart from other hospitals because they have been able to successfully make patient safety and reporting a regular part of their workflow and to balance the investment of resources that reporting often requires with their responsibility to care for patients.
All hospitals across the state should take note of the commitment and approach shown by Children’s Hospitals and the Mayo Clinic to re-engage with reporting tools like the Leapfrog Survey and dedicate resources to re-energizing their reporting efforts.
Why? Because aside from these three top-performing hospitals, fewer Minnesota hospitals are participating in voluntary patient safety reporting efforts like the Leapfrog survey. In fact, participation by Minnesota hospitals in this survey has decreased over the past 10 years. In 2010, just 22 of the 136 Minnesota hospitals completed the survey. And although Minnesota hospitals are making progress against many patient safety measures, overall scores are declining in key areas like heart attack and pneumonia.
The exception to that trend is Children’s Hospitals and Mayo Clinic. At Children’s Hospitals, patient safety initiatives have helped the hospital achieve one of the lowest rates of hospital-acquired infections in the nation, and their use of electronic medical records has helped further reduce patient complications and to improve patient care.
Mayo Clinic’s receipt the Top Hospital ranking is due largely to that organization’s continued efforts to develop evidence-based improvements and to adopt cutting edge, high standards of patient care across the organization. For example, every employee⎯from office staff, care providers, all the way up to the CEO⎯are encouraged to participate in the Mayo Quality Fellows Program or take individual and team courses at Mayo's Quality Academy to improve quality, safety and efficiency in their work area.
From the purchaser perspective, the Leapfrog survey is the most comprehensive survey of hospital patient safety. The survey reports on three key areas that are important to health care consumers: 1) how patients fare in a particular hospital, 2) the resources that hospital uses to care for patients, and 3) hospital management practices that promote safety. When it comes to investing in reporting that consumers can actually use, the Leapfrog Survey effectively connects hospital performance with consumer information needs.
With all the negative and conflicting reports on the state of patient safety across the country, Minnesotans should be proud that they have three top-performing hospitals in their midst. Not only have these hospitals made a long-term commitment to improving patient safety, but equally important, they have committed to publicly reporting on their processes and outcomes based on what the purchasers want. Without this information, individuals cannot make informed decisions about where they receive care based on understandable and useful information.
Patient safety is not a competition, but rather something that every hospital should strive to achieve. Not only is improving patient safety essential for improved health outcomes, but it also addresses the overall problem of ever-increasing health care costs. The health care industry cannot expect purchasers⎯whether individuals or employer purchasers⎯to continue to foot the bill for care that is inefficient and of poor quality.
As health care reform initiatives are implemented in the coming years, employers and individual consumers will be driven to make purchase decisions based on factors other than cost. Patient safety outcomes are likely to be at the top of that list. As employer purchasers, health care decision makers and industry leaders, we need to work together to increase participation in the Leapfrog survey by Minnesota hospitals, because it is this level of public reporting that will truly make a difference in improving patient safety for all Minnesotans.
In the spirit of collaboration,
Carolyn Pare
President & CEO
Buyers Health Care Action Group
