Real Quality: no more lip service

Hospitals have most likely responded (let’s hope) to CMS’s decision to not pay for a number of medical problems arising from hospital mistakes.

Good news. CMS has come out with a proposal to not pay for nine more preventable conditions.

Is quality getting the attention it deserves at your hospital?

My guess is (and probably dependent upon your role in the organization) that the answer is “not really.” We all know it is important. BUT! Some hospitals take quality very seriously. Most are just trying to figure out how to prevent the conditions CMS won’t reimburse for. And some hospitals probably shouldn’t be in business. It’s the bell curve. We need to shift that curve to the right.

Hospitals have been entangled in an epic struggle to stay clean since the days of Semmelweis (maybe a few years later). We’ve all seen the posters, maybe participated in a class, possibly evaluated the data. It’s been going on for years.

We know what hand washing (or alcohol sanitizing) can do. Here’s quick refresher if you have forgotten. Yet compliance rates are still poor. What is the problem? My take: accountability.

It’s time to stop paying lip service to quality. High quality is not adding a sentence to a mission statement. It’s not reporting required data to CMS. It’s not telling employees that quality is our top priority.

It is action. As an extreme, think of how good hand washing compliance would be if the person in charge said, “You will wash your hands at every appropriate moment or you will not have a job tomorrow.”

I’m a big fan of a blame-free environment. Report, report, report! But there needs to be balance. From the the New England Journal of Medicine, “But if we really are serious about making care safer, I would argue that we need to find the right balance between blaming mistakes on systems and holding individual providers accountable for their everyday practices.”

We must find the resources to make quality our top priority. Period. In an era when patients will demand to know everything quality-related about our services, we must be ready and willing to comply. CMS has provided the “business case” by ending reimbursements for hospital mistakes (and are working to reinforce the issue by extending the list). The question is, do you want to lead the way (and by proxy, define what high quality is) or slowly follow? The right side of the curve will be filled with leaders. Organizational success will follow.

UPDATE: Coincidentally, two quality related stories today: Cigna is following the CMS lead and the GAO says the feds haven’t done enough to establish quality and infection control guidelines in hospitals

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