By Donald Berwick, M.D., Administrator, Centers for Medicare and Medicaid Services
America has doctors, nurses, and hospitals second to none in the world. Every day, countless Americans receive superb care. But it's also often true that—for many patients—quality falls short of the highest standards.
Most of us wouldn't get on a plane that had known lapses in safety or whose pilot skipped the checklist. It's no more acceptable to overlook safety as a top priority in health care.
Nevertheless, on average, one of seven Medicare beneficiaries is harmed in the course of a hospitalization, costing the government an estimated $4.4 billion every year. A study published in April 2011 in the journal Health Affairs found, on average, one of three patients admitted to the hospital suffer a medical error or adverse event. These rates take a heavy toll. They are not due to deficiencies in the workforce. That is, they are not the fault of the doctors, nurses, managers, and staff who try hard every day to protect patients from the risks of complications in their care.
Nonetheless, the toll is unnecessary. The risks and harms to patients come from flaws in the design of the health care system, itself. Even the most committed professional can't make up for a system that leaves a patient on his own once he leaves the hospital or that lacks built-in safeguards to ensure patients don't get the wrong medicine, protect surgical wounds from infection, and make it easy and reliable for clinicians to wash their hands.
With hard work and ingenuity, we can continue to encourage all that is right about American health care while we work to fix what is wrong. It will take universal recognition that improvement is necessary and possible, along with clear vision and strong leadership for how we can get there.
That's where the Partnership for Patients comes in. It's a unique public–private partnership among those who provide care, receive care, and pay for care. It's a true collaborative effort.
Private and public stakeholders have pledged to reduce harm in hospitals by 40 percent in the next three years. This includes reducing the number of preventable in-hospital medication errors, central line–associated bloodstream infections, patient falls, and other injuries. It also intends to help patients heal successfully after discharge, so they don't have to go back to the hospital. We aim to reduce 30-day hospital readmissions by 20 percent over the next three years by targeting unnecessary return admissions.
Better, safer, cost-effective care will come from improving quality. In business, we see it all the time. Computers today do more than ever, at a continually lower price, as do cars, televisions, and telephones. Air travel is ultra-safe today in part because we've designed planes and systems that protect pilots against inevitable human error.
The Partnership for Patients has the potential to save up to $35 billion in health care costs in the next three years, including up to $10 billion for Medicare. Over the next 10 years, the Partnership for Patients could reduce costs to Medicare by about $50 billion and lead to billions more in Medicaid savings.
Hospitals across the country already are proving that this strategy works:
- Ascension Health—the country's largest nonprofit system—reduced its preventable deaths by 1,500 annually. As a result, malpractice costs dropped 36 percent between 2005 and 2010.
- Denver Health has been able to save over $100 million and achieve the lowest case-mix adjusted mortality among all the members of the University Health System consortium.
- Virginia Mason Medical Center in Washington State went from 34 cases of ventilator-associated pneumonia in 2002 at a cost of $500,000, to one case in 2005, at a cost of $15,000.
National Business Coalition on Health (NBCH) members are critical to this effort. NBCH was out in front early, marshaling corporate America to promote value-based purchasing. To make gains in patient safety across the country, we need the kind of leadership NBCH knows how to provide.
No one in the health care system can do this alone. Simply telling America's doctors and nurses to "try harder" to make patients safe would be like asking pilots not to crash. It's not the people that create the hazards; it's the design of the systems in which the people work.
Hospitals, doctors, nurses, pharmacists, health plans, patient advocates, patients and their families, and employers. When it comes to improvement, we're all in this together. If you haven't already joined forces with the Partnership for Patients, take the pledge at http://www.healthcare.gov/center/programs/partnership/ now.
Already, more than 5,000 organizations—including nearly 2,500 hospitals—have pledged their support for the Partnership for Patients. We should not stop until every health care purchaser and provider, worker and employer, patient and family member makes it their top priority to advance health care that is safe, efficient, and helping to keep our country well.
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