Progress in healthcare safety has been abysmally slow in the past decade as a result of incorrectly organized incentives, according to Harvard University (Cambridge, Mass.) professor and healthcare quality measurement expert Ashish K. Jha, MD, MPH, in an interview in Forbes.
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Some of Dr. Jha's insights as to why patient safety progress operates at a slow crawl include:
- A shift in thinking about medical errors, transferring the blame from the individual to the system, means slow improvements in the system necessarily hinder patient safety progress.
- Organizations, rather than individuals, stand to benefit most from incentivizing payments intended to improve patient safety. Relatively speaking, tying 20 percent of organizational revenue to patient safety has much more potential for consequences than does tying 20 percent of physician salaries to patient safety.
- Patient safety registers higher on CMOs' and CQOs' radars than it does on CEOs' radars. "I…haven't heard about any CEO who got fired because the hospital's infection rate was too high. It doesn't happen, and that's telling," said Dr. Jha.
- Readmissions is a surrogate for quality, and it may not be the best option, because it doesn't discriminate among the myriad of potential reasons — many not tied to quality of care — for readmission. A better one may be to invest heavily in the primary care system. Rethinking quality metrics by prioritizing the long-term over the short term may create positive change.
"I think the biggest thing that hinders us is the lack of clear and strong incentives for making patient care safer. You can be a hospital with a mortality rate that's twice as high as your neighbor's down the street, and the financial consequences of that are pretty trivial. And while we continue to tolerate that kind of failure, we shouldn't be surprised that the progress is going to be slow," said Dr. Jha to Forbes.
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