MTM: What has been done to eradicate hospital acquired infections by The Leapfrog Group and other groups and has it been successful?
Leah Binder: Infection rates are declining, but more transparency and quality improvement are needed. Public reporting through Leapfrog has helped contribute to a decline in infection rates in hospitals. For example, the percentage of hospitals reporting a CLABSI rate of zero has steadily increased from 18.8 percent in 2013 to 25 percent in 2015. Transparency is key. Government-led collection of data on health care-associated infections allows health systems to submit system level data. Leapfrog, however, is the only source of information on infection rates by hospital. By encouraging hospitals to submit this data and by holding them to a set of standards, we’re able to showcase the level of care consumers deserve.
MTM: In your capacity as CEO of The Leapfrog Group how are you working with other groups to ensure patient safety? Please share some of your success stories.
LB: During the last few weeks of pregnancy, critical fetal development is still occurring. Yet some mothers request that their baby be born sooner than their due date. These are early elective deliveries: inductions or cesarean sections performed prior to 39 completed weeks gestation without medical necessity. These procedures carry significant health risks to both mom and baby, and can also result in NICU admissions, increased length of stay, and higher costs to patients and payers. The American College of Obstetricians and Gynecologists (ACOG) has advised against these deliveries for over 30 years. In 2010, The Leapfrog Group first publicly reported rates of early elective deliveries by hospital. That year, the national average rate was 17% a shocking figure.
But that public reporting accelerated longstanding efforts by a network of organizations working to eliminate unnecessary deliveries, including the Catalyst for Payment Reform, the National Business Group on Health and the March of Dimes. At the Centers for Medicare & Medicaid Services, both the Partnership for Patients Program and the Strong Start for Mothers and Newborns Initiative identified early elective deliveries as a top priority issue early in 2012, and have both aligned their resources to achieving these results. Five years later, we have seen tremendous progress. From 2010 to 2015, the national rate plummeted to just 2.8% well below the standard set by Leapfrog of 5%.
The vast majority of states are now reporting early elective delivery average rates of less than 10 percent. Dramatic improvements from states like South Carolina were precipitated by payment reform penalties enacted by government and private sector stakeholders to discourage the practice of early elective deliveries. In other states, local coalitions were instrumental in leading the charge. In Illinois, the Midwest Business Group on Health spearheaded their own “Preventing Early Elective Deliveries” project, which effectively reduced the state rate from 22% in 2010 to 2% in 2015. This is one of the most extraordinary examples of progress in health care that I’ve seen in my career. It shows that public reporting can galvanize change, and that saves lives.
MTM: What are the three main goals of The Leapfrog Group and how are they being accomplished?
LB: Leapfrog’s mission has long been to trigger giant leaps forward in safety, quality and affordability of US health care. We envision a four-prong future where: • Purchasers tie health care investment to excellence and educate employees on choosing the best care. • Health plans support purchasers in their efforts. • Consumers fight for the best possible care. • Providers are courageous in championing transparency.
With these goals in mind, through several initiatives, we aim to use transparency to support informed health care decisions and promote high-value care. One of these initiatives, the Leapfrog Hospital Safety Grade assigns more than 2,500 hospitals letter grades (A through F) twice annually, in an effort to showcase how hospitals are performing in keeping patients safe from preventable harm and medical errors.
MTM: Improving patient safety has been a goal for almost 20 years yet medical error is the third leading cause of death. What changes need to be made to make hospitals safe?
LB: The issue of patient safety remains a sideline debate, not front and center where it belongs. In some hospitals, patient safety is a top priority, and strong health care teams reduce infection rates, put checks in place to prevent mistakes and ensure strong lines of communication between hospital staff, patients, and families. But that’s not the case everywhere. Hospitals need to prioritize patient safety and develop an institution-wide culture of safety. The issue goes beyond hospitals though. Patients must be educated and informed of their right to safe health care. They must demand it. This in turn holds hospitals to a standard. If a patient is unhappy with their hospital’s performance we encourage them to reach out to hospital leadership.
MTM: How do you involve policy makers, and at what levels, to improve patient safety?
LB: The sad truth is that patient safety rarely, if ever, is discussed politically. Many health systems are not motivated to prioritize safety, because there are no tough consequences, either from the market or the government. Policymakers can demand full transparency and tie payments to safety excellence and improvements. Today about one percent of Medicare payments to hospitals are tied to safety – a good start – but this commitment should be applied to other settings and involve higher financial stakes.
MTM: How can we, the US, establish and sustain a culture of safety in all hospitals?
LB: As stated above there are no consequences.
MTM: How will healthcare establish systems that protect patients and eradicate harm?
LB: It will only when tied to higher financial stakes and policymakers demand full transparency as stated above.
MTM: What training must be instituted and at what levels to ensure hospitals are safe for patients?
LB: Safety must be a critical priority that starts with the executive suite in a hospital and filters down through every single staff member. Hospitals that employ a culture of safety are much safer than those that do not make safety an institutional priority.
MTM: Simple things like hand washing are still not a uniform procedure, what can be done to ensure that it is?
LB: It’s well known that hand hygiene is one of the most important and effective means to stop the spread of infections in health care facilities (CDC), but you’re correct, many hospitals still don’t have a sound policy in place to ensure this is happening. It’s simple, any clinician or health care worker entering a patient’s room should wash his or her hands upon entry. Though unfortunately there’s no standardized measurement for reporting hand hygiene compliance at this time, The Leapfrog Group has put in place a set of recommended hand-hygiene safe practices aiming to minimize hospital-acquired infections through mandated and enforced proper handwashing protocols for all staff. It boils down to transparency. The more that hospitals report on these standards through the Leapfrog Hospital Safety Survey, the more inclined they’ll be to improve.
MTM: What can Leapfrog and other safety groups do to establish healthcare standards and to mandate that there is compliance?
LB: The Leapfrog Hospital Survey is one way hospitals demonstrate transparency by voluntary participation but as mentioned above there is no standard protocols throughout.
MTM: There are many instances where patients do not do what they are advised to do once they are discharged. Does The Leapfrog Group have any initiatives to help patients maintain their required healthcare practices?
LB: Leapfrog provides education to patients on how to choose the safest and highest quality hospital for their care, as well as how to talk to their doctor about safety. There are many other organizations that provide guidance to patients on post-discharge care.
MTM: Could you talk about the culture of ‘openness’ and the sharing of ‘data’ and ‘best practice’ and what metrics are needed as many hospitals do not report metrics and many states do not have specific reporting requirements. How can we foster reporting and sharing?
LB: Transparency is critical to improvements in health care. By transparently reporting data on quality and safety metrics, hospitals can demonstrate their commitment to improvement and reassure their patients that they will be open with their community on efforts to work towards providing the best care. Our consumer testing and focus groups have shown that patients are more concerned by a hospital that is unwilling to report data and be transparent than by one that is doing poorly but at least putting their information out there. The Leapfrog Hospital Survey, which any hospital can participate in, is a hospital’s best opportunity to demonstrate its commitment to transparency, and nearly 2,000 hospitals have accepted that charge. MTM
Biography Leah Binder is a regular contributor to Forbes.com, the Huffington Post, and the Wall Street Journal expert forum. She was named on Becker’s list of the 50 most powerful people in healthcare in 2014, and consistently cited by Modern Healthcare among the 100 most influential people and top 25 women in healthcare.