Monday, August 24, 2009

Happy Meals in healthcare: Not the Top Chef edition

Measuring quality and safety in healthcare is a process currently in the "Happy Meal" stage of development.

Packages like The Joint Commission's "Core Measures" target a small number of high-frequency, reasonably well understood disease processes, then measure how well people treated in hospitals receive standard, evidenced-based interventions. At their best, core measures mean people with conditions like congestive heart failure and community acquired pneumonia receive the care most likely needed to treat their condition and reduce the risk of complications whether they're in Denver, CO or Dahlonega, GA. Kind of like a #2 Value Meal is the same burger, fries, and Coke everywhere you go.

The Joint Commission's National Patient Safety Goals (NPSG) are another set of menu items. These measures identify error-prone places in systems used to deliver care, then specify practices individuals, teams, and organizations should take to minimize the risk of harm-causing errors. Many emerging norms, like "read back and verify" (used when high-stakes information is transmitted verbally) and fall prevention programs, are driven by NPSGs.

Accreditation bodies use performance on these standards when evaluating an organization's quality. So do payors (including Medicare, Medicaid, and a host of private insurers) with reimbursement schedules increasingly tied to performance. Consumers are seeing evidence of them, too. As I travel around the country, I notice remarkably similar billboards announcing awards received by local hospitals for their performance in highly visible measures of care.

This is a huge step forward in defining expected outcomes and making the processes used to achieve them more transparent. (It's worth remembering that until the IOM report To Err is Human was published 10 years ago, the possibility that patients were harmed as a result of seeking care was not discussed, let alone quantified or seen as the threat to public health that it is.)

I've been a registered nurse for nearly 25 years. And before that, a waitress. So I can tell you from experience that a boxed lunch is not the worst thing that can come of a kitchen.

Current measures and methods for measuring quality are imperfect. They're stymied by a host of confounding variables, but the science of measuring what's good, bad, and ugly in healthcare will mature. Being able to see what's on the menu is a good first step, but Happy Meals aren't satisfying and they're not enough to sustain us over time.

No comments:

Creative Commons License
Florence dot com by Barbara Olson is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 United States License.