Think Globally: Quality and Safety in American Medicine

The publication of two Institute of Medicine (IOM) reports-To Err is Human: Building A Safer Health System in 1999 and Crossing the Quality Chasm: A New Health System for the 21st Century in 2001-served as a catalyst to increase awareness among health care professionals that the American health care system is beset by serious problems related to patient safety and medical errors.

Since then, knowledge and opinion leaders in the health care industry, such as Kenneth I. Shine, MD, who was President of the IOM when these studies were done, have strived to improve this situation so that America’s health care system is safe, effective, patient-centered, timely, efficient, and equitable.

They envision a system that uses the best knowledge, is focused intensely on patients, and works across health care providers and settings. Achieving this ideal will require crossing a large chasm between today’s system and the possibilities of tomorrow.

I am pleased that the president of the American Head and Neck Society chose ‘quality’ as the overall theme for the 2007 COSM in San Diego, said Dr. Shine, who is now Executive Vice Chancellor in the Office of Health Affairs of the University of Texas System in Austin. This speaks well for this organization and its commitment to improve quality and safety.

Bridging the Quality Gap

During his John J. Conley Lectureship presentation at COSM, Dr. Shine listed 10 rules that are necessary to redesign care, in order to bridge the quality chasm:

• Care based on continuous healing relationships between health care professionals and patients.
• Customization based on patient needs and cultural values.
• Patient as source of control.
• Shared knowledge and free flow of information.
• Evidence-based decision-making.
• Safety as a systems property.
• Transparency (health care facilities need to make outcome data public).
• Anticipation of needs.
• Continuous decrease in waste.
• Cooperation among clinicians.

Many of these rules are in the process of being implemented, but not all of them at the same time, said Dr. Shine.

For example, safety as a systems property is already under way in some institutions that are using computerized physician order entry (CPOE) systems. CPOE can be remarkably effective in reducing the rate of serious medication errors. A study led by David Bates, MD, Chief of General Medicine at Boston’s Brigham and Women’s Hospital, demonstrated that CPOE reduced error rates by 55%-from 10.7 to 4.9 per 1000 patient days. Rates of serious medication errors fell by 88% in a subsequent study by the same group.1