Con­demned to re­peat it

This much we know: Qual­ity im­prove­ment stalls and Scott’s not learn­ing

Modern Healthcare - - Opinions Editorials -

Notes on the news: Let’s talk a lit­tle about at­ten­tion. My col­league David May noted last week on this page (April 12, p. 22) that re­cent data showed progress in pa­tient safety to be a mixed pic­ture at best.

As if to un­der­score the point, the gov­ern­ment then is­sued a new and dis­mal study on qual­ity. In its an­nual re­port, the Agency for Health­care Re­search and Qual­ity said hos­pi­tals in 2007—the lat­est year for which data were avail­able—con­tin­ued to see in­creased rates of post­op­er­a­tive sep­sis and catheter-as­so­ci­ated uri­nary tract in­fec­tions. The re­port cited “very lit­tle progress” on elim­i­nat­ing hospi­tal-ac­quired in­fec­tions and called for “ur­gent at­ten­tion” to the task of cor­rect­ing the sit­u­a­tion.

One sil­ver lin­ing in the study: There was a 12% drop in post­op­er­a­tive pneu­mo­nia.

The de­press­ing news comes a decade af­ter the In­sti­tute of Medicine turned a na­tional spot­light on the epi­demic of med­i­cal er­rors and pre­ventable deaths.

Just be­fore the gov­ern­ment is­sued its re­port, qual­ity guru Lu­cian Leape ad­dressed the Amer­i­can Or­ga­ni­za­tion of Nurse Ex­ec­u­tives’ an­nual meet­ing in Indianapolis. As re­porter Joe Carl­son re­counted (Re­porter’s Note­book, ModernHealth care.com), Leape didn’t pull any punches in his as­sess­ment of the cur­rent state of af­fairs: “I think it’s safe to say the pa­tient-safety move­ment has been a great fail­ure.” He added, “No one to my knowl­edge has im­ple­mented all 34 pro­to­cols from the Na­tional Qual­ity Fo­rum. Why not? Why isn’t that pri­or­ity No. 1 for all hos­pi­tals in Amer­ica?”

Leape’s com­ments were echoed by Joan Thomas, a reg­is­tered nurse and a Uni­ver­sity of Mem­phis (Tenn.) as­so­ciate pro­fes­sor. She said, “Maybe there have been a few tweaks here and there, but no trans­for­ma­tion has come.”

Things may change soon. The new health re­form law calls for penal­ties for hos­pi­tals with high in­fec­tion rates start­ing in fis­cal 2015.

It’s cer­tainly pos­si­ble to change. Carolyn Clancy, AHRQ’s di­rec­tor, said projects have shown that you can re­duce in­fec­tion rates with an in­tense fo­cus on safety pro­ce­dures.

So here’s a man­age­ment ex­er­cise: If the staff at your in­sti­tu­tion isn’t pay­ing at­ten­tion to pa­tient safety, what is it fo­cus­ing on in­stead—and why?

And speak­ing of man­age­ment, it ap­pears Rick Scott has be­come the Rod Blago­je­vich of health­care.

Last week, Scott, the for­mer chief of Columbia/HCA Health­care Corp., an­nounced that he is run­ning for the Repub­li­can nom­i­na­tion for Florida gov­er­nor. As some will re­mem­ber, Scott caught the at­ten­tion of the in­dus­try by turn­ing Columbia into a cor­po­rate bull­dozer that wound up pay­ing a $1.7 bil­lion fraud set­tle­ment with the fed­eral gov­ern­ment. Years af­ter his ouster from the com­pany, Scott resur­faced as leader of Con­ser­va­tives for Pa­tients’ Rights and del­uged the air­waves with ads sug­gest­ing that re­form leg­is­la­tion would force Amer­i­cans into health­care gu­lags.

Hav­ing lost that war, Scott’s cam­paign said he planned to open his bid for gov­er­nor with a $1.5 mil­lion ad buy. Mean­while, the man­age­ment at HCA, which is plan­ning an ini­tial pub­lic of­fer­ing, must be cring­ing at the thought of Scott call­ing at­ten­tion to the un­for­tu­nate past. It’s un­clear how much they need to worry about this—the news me­dia flits from one story to an­other with no mem­ory of the past, and most Amer­i­cans have the at­ten­tion span of gnats.

If Scott loses this new cam­paign, which is likely, there will be many op­por­tu­ni­ties to in­dulge his ego. Like Blago­je­vich, the disgraced ex-gov­er­nor of Illi­nois, he can go on “Celebrity Ap­pren­tice” and get him­self fired. Or he can get his own ra­dio talk pro­gram. Or he can run for pres­i­dent.

One way or the other, Scott will make sure at­ten­tion is paid.

NEIL MCLAUGH­LIN

Manag­ing Ed­i­tor

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