You might not expect a hospital to advertise its errors, but that's what the public wants. And that's what the New York City Health and Hospitals Corporation is doing, according to Alan Aviles, the group's president.
In July, Mr. Aviles announced that the group's 11 hospitals would publicize their overall mortality rates, heart attack mortality rates, and rates of nosocomial infections, including central line, ventilator-associated, and surgical site infections.
Nineteen states, including New York, have legislation requiring the public reporting of nosocomial rates. And legislation adopted in 2005 requires New York hospitals to report their incidence of central line bloodstream infections, and coronary artery bypass graft and colon surgery site infections, to the state health department.
It's unclear when that information might be made public and whether it will appear as aggregate or facility-specific information. But Mr. Aviles has taken the bull by the horns because hospitals can't do a better job until they can see the job they're already doing, he said in an interview.
“One of the biggest problems in this industry is the extent to which we keep this kind of quality-related data close to the vest. The practical result of that attitude is that we expect our physicians to make improvements while they're groping around in the dark. They never have the benefit of knowing what we—or others—are achieving and where we stand on that spectrum.”
Publicly disclosing what has always been considered a hospital's deepest secrets is the only way to fix them, he said.
Mr. Aviles has had his share of naysayers, including those within his own system who worried that public scrutiny could nick their competitive edge among the city's 60 hospitals. “There was concern that we could be impacted competitively if the public either misinterpreted the data or if the numbers aren't as good as those of the competition,” he said. “But people know that medical errors and hospital-acquired infections cause thousands of needless deaths each year. They know there needs to be significant focus and improvement on these, and this transparency can only help.”
To that end, Mr. Aviles and his team have set a lofty goal: By 2010, they want to have the safest hospitals in the country.
There's no mistaking the single-mindedness behind that goal, said Jim Conway, senior vice president of the Institute for Healthcare Improvement (IHI). “It's extraordinarily courageous and extraordinarily hard,” he said in an interview. “They're willing to be held accountable not only to their own staff, but to consumers, patients, and families.”
The nonprofit IHI supports transformational change in health care quality and safety, both in the United States and internationally. Its “Five Million Lives Campaign,” launched in 2006, aims to protect patients from 5 million incidents of medical harm by the end of 2008. To achieve that, at least 4,000 hospitals will have to commit to improving patient safety. At present, 3,500 are involved.
The lofty goals set by the IHI and Mr. Aviles' group are a hallmark of successful change in health care systems, Mr. Conway said. Another example is Ascension Health System, which comprises 65 hospitals across the United States and aims to eliminate all preventable harm in all of their hospitals by 2008. “We're seeing the fruits of that goal. In almost every tracked indicator, their performance is much better than almost any other system in the country. For pressure ulcers, for example, the rate in their lowest-performing hospital is one-sixth that of the national average,” Mr. Conway added.
Cincinnati Children's Hospital is trying to eliminate 80% of preventable serious harm, including hospital-acquired infections, by July 2008, according to Mr. Conway. Beth Israel Deaconess Medical Center in Boston has become the first hospital to post its 2007 Joint Commission Accreditation Survey findings on its Web site. The center also publicly posts its commitments to quality improvement, including the complete elimination of ventilator-associated pneumonia and central line infections.
“What drives organizations to accomplish goals like these?” Mr. Conway asked. “They have a great vision, and they have a solid sense of their current reality. They understand the gap between where they are and where they need to be, and they use that tension to drive change.”
Goals in these organizations are specific and measurable—eliminating 100% of central line infections by a certain date, for instance, as opposed to a broader aim of delivering the best health care.
“We've come to understand that 'some' is not a number and 'soon' is not a time,” Mr. Conway said. Just as importantly, everyone from the chief surgeon to housekeeping is considered responsible, he added.