Safe, effective, patient-centered, timely, efficient, and equitable are, unfortunately, not words commonly associated with health care. They are the areas for improvement advanced by the Institute of Medicine as they defined the idealized health care system in a recent report.
Increasingly, most of us are frustrated with the fact that for all the wonderful things the health care system does, much of the experience doesn’t meet our needs. Unlike the Bob Dylan song, "Everything is Broken"—which laments the aspects of our daily life that fall short of their potential and don’t delight us—we face a wonderful opportunity when it comes to health care. We can fix it.
Currently, most hospital patients get very good care, just like most airline passengers get their luggage delivered at the same time they arrive. Those of us who fly regularly know how commonly luggage does not arrive—an error rate of about 12,000 per million, or what is called 3 sigma. Mishaps on takeoffs or landings, however, occur at a 6 sigma performance rate, or about 3 times out of a million. Regrettably, most health care processes operate at less than the performance of airline baggage handling. Can we fix baggage handling? Yes. Can we fix health care? Yes. We can, and we will.
What will it take? Simplistically stated, three things—the will (intent) to do it, a plan and resources. All three are, in fact, already in place and producing change in our system. National initiatives advanced by federal and state government (they purchase almost half of health care); business coalitions like The Leapfrog Group (Fortune 500 companies who provide health insurance to approximately 25 million working Americans); and private and public foundations, like the Robert Wood Johnson foundation, are raising the performance bar.
Pursuing perfection is now the target. These initiatives are the reasons for a national agenda to create the intent to change are born. They are identifying the tool kits to facilitate change, and health care is responding by building new infrastructure—people and their skills, systems, and standard operating procedures that will support the change. Central to these efforts is the incorporation of knowledge from other segments of the economy like safety engineering, systems engineering and human resource science. Technology—particularly information management systems that put clinical information in the hands of caregivers at the point of care and allow access to evidence- based decision support—will allow clinicians to make the right choices and produce optimal outcomes. Reducing variation through standardization is beginning. While a few decry these efforts as cookbook medicine, most clinicians welcome the help.
It must be noted that inexpensive was not one of the listed aims of the Institute of Medicine ideal health care system design. The challenges of fairly compensating nurses and other caregivers to help assure we can attract and retain good people are real.
The significant costs of information technology—as much as $100 million a year for some large systems—must be incorporated into operational budgets already returning margins that will not generate enough cash to fund future capital investment needs. The continued burden of uncompensated charity care and funding of care for the 50 million uninsured Americans are social problems we, as a society, must address.
These are challenging and exciting times in health care. It appears to many we have an opportunity to finally get it right. Safe, effective, patient-centered, efficient and equitable care is within our grasp. IBI