Those involved in training - whatever the industry - understandably have a focus on performance. In fact, obtaining appropriate human performance, and measuring it, is at the heart of all that we do. Communication with industry will be key, including a common vocabulary and taxonomy, as well as the ability to accurately measure safety outcomes and efficiencies.
The prior paragraph was shamelessly borrowed from my colleague Chris Lehman, editor of CAT (The Journal for Civil Aviation Training) and he was talking about the airline industry. As we know the US aviation industry has a remarkable safety record. In the last MEdSim issue our publisher, Andrew Smith, talked about a week in July 2014, when there were three airplane crashes. In all 462 passengers were killed and it was on every television channel for days. When the Russians shot down a passenger plane it was on every channel. Yet 1000 avoidable deaths a day occur in the US health system and countless others around the world and there is limited television, newspaper or internet coverage.
The same day as the first airline crash, July 17th, there was a Senate Subcommittee hearing on the need to improve patient safety and discuss why the third leading cause of death in the United States is avoidable error. The following expert witnesses were called to testify before the committee:
- John James, PhD, Founder, Patient Safety America, Houston, TX
- Ashish Jha, MD, MPH, Professor of Health Policy and Management, Harvard School of Public Health, Boston, MA
- Tejal Gandhi, MD, MPH, President, National Patient Safety Foundation; Associate Professor of Medicine, Harvard Medical School, Boston, MA
- Peter Pronovost, MD, PhD, Senior Vice President for Patient Safety and Quality and Director of the Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, MD
- Joanne Disch, PhD, RN, Professor ad Honorem, University of Minnesota School of Nursing, Minneapolis, MN
Members of this distinguished panel have written countless articles on performance, assessment, outcomes and patient safety. Perhaps one of the most widely distributed was Achieving the Potential of Health Care Performance Measures: Timely Analysis of Immediate Health Policy Issues, May 2013 by Robert Berenson, Peter Pronovost and Harland Krumholz. In the report they stated that, “measures have altered the culture of health care delivery for the better, with a growing acceptance that clinical practice can be objectively assessed and improved. There is a consensus that scientifically rigorous and valid measurement of performance can be instrumental in improving value in US health care.” However, in their report they cautioned that, “in an environment where both reputation and dollars depend on measured performance, it is often difficult to disentangle the legitimate concerns of those being measured from self-serving defenses of the status quo. Despite the broad demand for performance measures and the recognized limitations of current measures, the United States lacks an organization charged with advancing the science of performance measurement, developing standards for performance measures, setting parameters for how accurate the measures must be before they are used in pay-for-performance or public reporting initiatives, and coordinating the development of the large number of measures required to inform patient choice and monitor performance.”
This is where healthcare could learn a lot from other high risk industries such as the airlines, where ‘no fault reporting’ is mandatory and works, and is in place to ensure safety. Healthcare needs an equivalent to ‘no fault’ but because healthcare does not have a system for reporting or a framework to deal with reporting errors it cannot happen. Healthcare needs to standardize how they report outcome and measurements. As Jerod Loeb stated in 2004 “it is imperative that performance measures are standardized so that data collection efforts can be minimized.”
If the following Policy Recommendations from the above report are acted upon, healthcare will move more rapidly toward a culture of safety.
- Move from process to outcome measures.
- Adopt other quality improvement measures when measures fall short.
- Measure quality at organizational rather than clinician level.
- Measure patient care experience and reported outcomes as their own measure.
- Use measurement to make care safer.
- Invest in the “basic science” of measurement.
- Task a single entity with defining standards for measuring and reporting quality and cost data, similar to the role the SEC serves for the reporting of corporate financial data, to improve the validity and comparability of publicly-reported quality data.
Editor in Chief, MEdSim Magazine