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Public policy
Public Policy An Imperative for Change—Creating Safer Health Care Systems
O
N NOVEMBER 29, 1999, the Institute of Medicine (IOM) issued a report, To Err Is Human: Building a Safer Health System, which evoked considerable discussion in policy-making circles across the nation and garnered media attention from coast to coast. The report indicated that medical errors were the eighth leading cause of death in the United States accounting for 44,000 to 98,000 deaths annually, a rate surpassing deaths caused by motor vehicle accidents, breast cancer, or acquired immunodeficiency syndrome. The cost of these preventable adverse events was estimated to be between $17 billion and $29 billion annually. The report acknowledged that the health care industry was far behind other high-risk industries in creating a safe system, and called for action to reduce errors by 50 per cent over the next 5 years. The IOM report outlined a four-tiered approach with recommendations to achieve this goal: ● ● ●
●
Create a national focus on patient safety; Establish mandatory and voluntary reporting systems; Set safety performance standards and improvement expectations at both the health care organization and individual provider levels; Implement safe practices at the delivery level to create safety systems within health care organizations.
The IOM report has been the catalyst for a flurry of public and private sector activity. Early in December 1999, the President signed an executive memorandum directing the Quality Interagency Coordination Task Force (QuIC) to analyze the study and report back within 60 days with specific action steps. The 106th Congress, in traditional fashion, held hearings on the topic and recently legislators have begun to introduce bills that adopt a variety of policy approaches to remediate the numerous problems highlighted in the IOM report. These bills include H.R.3672, which creates a voluntary reporting system to reduce medication errors, S2308, which establishes demonstration projects to identify the causes of medical errors and explore specific strategies to reduce errors, and, S2378, which mandates a medical error reduction program as a condition of participation in Medicaid and Medicare.
The private sector has also responded to the IOM report, as evidenced by the formation of The Leapfrog Group under the auspices of The Business Roundtable (BRT), an association of chief executive officers of 200 of America’s largest corporations. The “Leapfrog Initiative” encourages large employers to reward health plans and hospitals that make breakthrough improvements in patient safety. The Group plans to establish purchasing guidelines specifically designed to reduce medical errors, and then using purchasing power to force the health care market to be more responsive to quality demands. Most recently, consumers were also encouraged to protect themselves from errors in their health care. On April 4, 2000, the Agency for Healthcare Research and Quality (AHRQ), announced the release of a patient fact sheet, 20 Tips to Help Prevent Medical Errors, to assist patients in doing so by becoming active participants in health care decisions. Clearly, this has become a high-profile issue and it will likely remain a priority on the political agenda until corrective action is taken. A Kaiser Family Foundation survey documented public awareness of the issue, reporting that 51 per cent of Americans had closely followed the release of the IOM report and 42 per cent knew that the report indicated medical errors in hospitals were a serious problem, many resulting in preventable deaths (1999). The current compendium of proposed policy solutions rely almost exclusively on the creation of new regulatory mechanisms. The health care industry is currently governed by many regulatory requirements, some so onerous they have failed to accomplish their intended purpose. New regulatory proposals need to be carefully examined to avoid a similar fate. It must also be recognized that regulatory solutions alone are inadequate in achieving the goal set by the IOM. The most difficult task lies in the hands of those who work in the health care system, to create a culture that proactively promotes patient safety. The design of safe systems requires both an understanding of the sources of error and interventions to minimize risk. This task presents a new challenge for all nurses; not just those in practice settings, but also those engaged in education and research endeavors. Research is requisite to better understand the sources of error, and curricula need to focus to a greater extent on patient safety and strategies to reduce the inherent risks encountered in complex systems. References
BARBARA E. LANGNER, PHD, RN Visiting Scholar Institute for Health Services Research and Policy Studies Northwestern University 339 E Chicago Ave, Room 715 Chicago, IL 60611 Copyright © 2000 by W.B. Saunders Company 8755-7223/00/1606-0003$10.00/0 doi:10.1053/jpnu.2000.18170 310
Agency for Healthcare Research and Quality Patient Fact Sheet. (2000, February). 20 tips to help prevent medical errors (AHRQ Publication No. 00-PO38). Rockville, MD: U.S. Department of Health and Human Services. Institute of Medicine. (1999). To err is human: Building a safer system. Washington, DC: National Academy Press. What the public understands about health stories in the news. (1999, November/December). The Kaiser/Harvard Health News Index, 4, 1-2.
Journal of Professional Nursing, Vol 16, No 6 (November–December), 2000: p 310
O
N NOVEMBER 29, 1999, the Institute of Medicine (IOM) issued a report, To Err Is Human: Building a Safer Health System, which evoked considerable discussion in policy-making circles across the nation and garnered media attention from coast to coast. The report indicated that medical errors were the eighth leading cause of death in the United States accounting for 44,000 to 98,000 deaths annually, a rate surpassing deaths caused by motor vehicle accidents, breast cancer, or acquired immunodeficiency syndrome. The cost of these preventable adverse events was estimated to be between $17 billion and $29 billion annually. The report acknowledged that the health care industry was far behind other high-risk industries in creating a safe system, and called for action to reduce errors by 50 per cent over the next 5 years. The IOM report outlined a four-tiered approach with recommendations to achieve this goal: ● ● ●
●
Create a national focus on patient safety; Establish mandatory and voluntary reporting systems; Set safety performance standards and improvement expectations at both the health care organization and individual provider levels; Implement safe practices at the delivery level to create safety systems within health care organizations.
The IOM report has been the catalyst for a flurry of public and private sector activity. Early in December 1999, the President signed an executive memorandum directing the Quality Interagency Coordination Task Force (QuIC) to analyze the study and report back within 60 days with specific action steps. The 106th Congress, in traditional fashion, held hearings on the topic and recently legislators have begun to introduce bills that adopt a variety of policy approaches to remediate the numerous problems highlighted in the IOM report. These bills include H.R.3672, which creates a voluntary reporting system to reduce medication errors, S2308, which establishes demonstration projects to identify the causes of medical errors and explore specific strategies to reduce errors, and, S2378, which mandates a medical error reduction program as a condition of participation in Medicaid and Medicare.
The private sector has also responded to the IOM report, as evidenced by the formation of The Leapfrog Group under the auspices of The Business Roundtable (BRT), an association of chief executive officers of 200 of America’s largest corporations. The “Leapfrog Initiative” encourages large employers to reward health plans and hospitals that make breakthrough improvements in patient safety. The Group plans to establish purchasing guidelines specifically designed to reduce medical errors, and then using purchasing power to force the health care market to be more responsive to quality demands. Most recently, consumers were also encouraged to protect themselves from errors in their health care. On April 4, 2000, the Agency for Healthcare Research and Quality (AHRQ), announced the release of a patient fact sheet, 20 Tips to Help Prevent Medical Errors, to assist patients in doing so by becoming active participants in health care decisions. Clearly, this has become a high-profile issue and it will likely remain a priority on the political agenda until corrective action is taken. A Kaiser Family Foundation survey documented public awareness of the issue, reporting that 51 per cent of Americans had closely followed the release of the IOM report and 42 per cent knew that the report indicated medical errors in hospitals were a serious problem, many resulting in preventable deaths (1999). The current compendium of proposed policy solutions rely almost exclusively on the creation of new regulatory mechanisms. The health care industry is currently governed by many regulatory requirements, some so onerous they have failed to accomplish their intended purpose. New regulatory proposals need to be carefully examined to avoid a similar fate. It must also be recognized that regulatory solutions alone are inadequate in achieving the goal set by the IOM. The most difficult task lies in the hands of those who work in the health care system, to create a culture that proactively promotes patient safety. The design of safe systems requires both an understanding of the sources of error and interventions to minimize risk. This task presents a new challenge for all nurses; not just those in practice settings, but also those engaged in education and research endeavors. Research is requisite to better understand the sources of error, and curricula need to focus to a greater extent on patient safety and strategies to reduce the inherent risks encountered in complex systems. References
BARBARA E. LANGNER, PHD, RN Visiting Scholar Institute for Health Services Research and Policy Studies Northwestern University 339 E Chicago Ave, Room 715 Chicago, IL 60611 Copyright © 2000 by W.B. Saunders Company 8755-7223/00/1606-0003$10.00/0 doi:10.1053/jpnu.2000.18170 310
Agency for Healthcare Research and Quality Patient Fact Sheet. (2000, February). 20 tips to help prevent medical errors (AHRQ Publication No. 00-PO38). Rockville, MD: U.S. Department of Health and Human Services. Institute of Medicine. (1999). To err is human: Building a safer system. Washington, DC: National Academy Press. What the public understands about health stories in the news. (1999, November/December). The Kaiser/Harvard Health News Index, 4, 1-2.
Journal of Professional Nursing, Vol 16, No 6 (November–December), 2000: p 310