The Core of Patient Safety (And Why Your Organization Should Pay Attention)

Probably no greater or more consequential trend exists in health care than the movement for quality improvement and patient safety. Every provider is trained and expected to increase the quality of care they deliver today, and even more so in the future. At the foundation of quality is patient safety and the quality processes that ensure it. Supply chain managers play a lead role in this movement, too: They are a core part of a quality improvement infrastructure.

Here’s a look back—and next steps as we move forward—on the march toward quality improvement.

The Origins of Patient Safety

While the modern day quest to improve the quality of care in medicine has its roots in the Hippocratric oath, first uttered in the 5th century B.C., meaningful changes in medical care are a modern invention. It took more than 2,000 years after Hippocrates for medical care to develop an external view of disease. In 1854, physician John Snow used analysis now common in epidemiology to extinguish a cholera epidemic in London by removing the Broad Street water pump handle. Three years later Ignaz Semmelweis began the practice of hand hygiene during child birth, and in 1861 Pasteur confirmed the germ theory of disease. Six years later Joseph Lister created and demonstrated the benefits of antiseptics for wound care. Antibiotics were dis- covered by Alexander Fleming in 1928, and these miracle compounds transformed health care in the 1940s and 1950s.

American Contributions to the Patient Safety Movement

America’s contributions to the quality movement began in the 1950s with the founding of the Joint Commission on Accreditation of Hospitals, consumerism and consumer protection movements, and the invention of the microchip enabling the information age. In the 1970s, the Institute of Medicine (IOM) was chartered, and three years later the Health Maintenance Organization (HMO) Act was passed. HMOs allowed organizations to take risk in disease management, and gain reward for resource stewardship. In the 1980s the march toward quality improvement hastened. In 1983 two Yale Management Scientists created a “product-line” orientation to health-care service delivery, which became the Diagnosis Related Group (DRG) bundled payment system. Grouping services was expected to improve efficiency and quality. In 1986, The Health Care Quality Improvement Act was passed, ushering in a new era of physician peer review by granting reviewers immunity from liability. In 1989, the Agency for Healthcare Research on Quality (AHRQ) was founded as part of the Department for Health and Human Services.

Rapid Change in the New Millennium

Following the IOM report, the Leapfrog Group was founded in 2000 by a consortium of large employers with the aim of accelerating quality process adoption in health systems. In 2002 the National Quality Forum released a list of 27 “Never-Events,” referring to particularly shocking medical errors (such as wrong-site surgery) that should never occur, and the Centers for Medicare and Medicaid Services (CMS) initiated voluntary public reporting of quality indicators. “Sentinel events,” or an unexpected occurrence involving death or serious physical or psychological injury not related to the natural curse of the patient’s illness, required immediate investigation and reporting to the Joint Commission. Providers were then required to conduct root cause analysis and make remedies.

In 2003, Congress enacted the Medicare Modernization and Accountability Act, which chartered The Joint Commission’s Healthcare Quality Accreditation Association. “Tracer” interviews that follow a patient record rather than examining policy manuals were implemented. In 2006 the CMS formalized a list of 10 Quality (Core) Measures for voluntary public reporting, adding seven more measures the next year. In 2008 the CMS promoted value- based purchasing and patient-centric care delivery models, themes that were incorporated in the 2009–2010 push toward health reform.

Why Your Organization Should Pay Attention

Today the Patient Protection and Affordable Care Act of 2010 includes regulations on quality-based payment, accountable care, bundled payments, clinical effectiveness and non-payment for hospital-acquired conditions and avoidable readmissions—all patient-safety-related features that originated in the last decade. As the future of U.S. health care is being debated, it is certain that payers, regulators and the public will continue to demand quality improvement in all aspects of health care delivery.

–Gunter Wessels

Photo courtesy of morrissey