Quality is Elusive but Necessary

If you ask 10 people to define healthcare quality, you’ll likely get 10 different answers. From the provider perspective, quality is hard to define, hard to implement and hard to measure; but all three are absolutely necessary. So it is disheartening when HHS releases a report that only 1 in 7 medical errors suffered by Medicare beneficiaries are reported and Shannon Brownlee writes that hospitals are still incredibly dangerous.

Medicare requires that adverse events (medical mistakes that lead to poor patient outcomes) be tracked by hospitals in the program. However, according to the HHS report, hospital administrations only hear about 14 percent of such events. Since only 14 percent are reported, what happens to the other 86 percent of adverse events?

According to the authors, 61 percent were incidents that the hospital staff did not see as reportable errors and 25 percent were mistakes that, while normally reported, were not in that particular situation for whatever reason. If the clinicians treating the patients did not deem a majority of what the study defined as “adverse events” as errors, then that indicates a faulty system. Perhaps CMS has interjected a definition of adverse events that doesn’t line up with the reality of clinical practice—this would not be the first time. The recent focus on publicly available quality stats, and creation of easily comparable hospital data could also be responsible for hospital clinicians who keep quiet about errors, not wanting their hospital to look bad.

There is probably no one reason and certainly no one answer to this difficult issue, but this makes it no less important. Hospitals need to change, but CMS may also need to revisit their definitions to line up with what those in medical practice see as errors. Because patient lives are at risk, this issue is too vital to be decided by health policy researchers in Washington. Every provider, payer and healthcare administrator needs to think about innovative ways to define, implement and measure quality healthcare because our current system clearly is not able to.