A consumer has spent several years on a hospital board, proud of their work to keep vital a key community organization. They know and respect many of the doctors and administrators in leadership. They are constantly shown information documenting the high quality care being delivered and the wonderful stories of how the hospital is saving lives and helping the community. Meanwhile, the hospital gets a C grade on the Leapfrog Hospital Safety Score, indicating people from the community are being unnecessarily harmed and unnecessary deaths are occurring. What is wrong with this picture?
DEATHS FROM HOSPITAL MEDICAL MISTAKES
In 1999, the Institute of Medicine released To Err Is Human, which provided the eye-opening statistic that 48,000–98,000 deaths occur annually due to preventable medical mistakes in hospitals. In 2014, researchers developed a new estimate: 244,000–488,000 deaths a year from preventable medical mistakes just in hospitals. Deaths from preventable medical mistakes in hospitals are the third leading cause of deaths in America more than breast cancer, automobile accidents, AIDS and other conditions combined.
During this whole time most hospitals in America were governed by consumers on their boards of directors. For consumer involvement to help change healthcare, we have to learn how consumers can become more savvy and more effective.
HAVE WE TURNED THE CORNER ON MEDICAL MISTAKES?
Hopefully, America may be finally turning the corner on this tragic situation. The Agency for Healthcare Research and Quality (AHRQ) recently announced a 17% reduction in hospital acquired conditions between 2010 and 2013. Recent shifts in payment reform from the Fee for Service system with no incentive for quality, to the many new programs where quality and safety improvement are key to full payment, offer hope for continued improvement. However, medical error rates are still way too high, leading to much unnecessary harm and costs. Consumers can help improve this, but it requires effort and organization.
In this series, I explore potential strategies for identifying and effectively involving consumers in improving healthcare quality.
· Part 1 identifies the types of consumers best positioned to drive change and discusses how organizations can identify, involve, and train these potential change leaders.
· In Part 2, I discuss the promising approaches to involving consumers in improving healthcare quality.
As in many other industries (e.g., autos, banking, retail, etc.), health care may need the customer to finally drive change. Today it is refreshing to hear care providers speak frequently and passionately about patient centered care. Unfortunately, for many providers that just means consumers/patients complying with what they are told to do. For true system change, consumers need to help change the attitude, culture, and behaviors embedded in the way health care is delivered. We can only hope that patients/consumers are becoming true customers of care − understanding value and considering their choices of plans, providers, and services. Most need support to do this well.
CONSUMERS WITH ABILITY TO CREATE CHANGE
Unfortunately, not all healthcare consumers are well-positioned to help catalyze health care quality improvements. Consumers with a rare combination of characteristics can most effectively use moral authority to drive change. They need to be:
1. Influential − on a decision making or influential advisory body, such as a health organization board or board level committee, state or local policy making board, etc. It has not been shown that everyday consumers have much ability to change things in health care (yet).
2. Knowledgeable − with enough knowledge about quality and cost measurement to confidently interact with health care providers who use authoritative language, tone of voice, and body language to “push back” against certain quality measures.
3. Empowered − motivated and not afraid to speak truth to power in a respectful collaborative way, so that others listen rather than respond patronizingly or write them off as an angry advocate.
4. Data-Focused − with access to credible and easy-to-understand objective quality and cost metrics and help to use them appropriately (e.g., Leapfrog Hospital Safety Scores developed by an exceptionally qualified blue ribbon panel).
FINDING THE RIGHT CONSUMERS FOR CHANGE EFFORTS
It is not always easy to find consumers with these characteristics. Two basic approaches are:
1. Activation: Look for consumers already in positions of influence and train and support them.
a. Find through social networking, surveys of consumer organizations, etc.
b. Develop just in time training program.
i. Quality 101 and 201
ii. Change methodologies
iii. Networking, motivating, and support strategies
c. Select or develop credible metrics that consumers can use and show them how.
2. Acquisition: Recruit and develop consumers who can join bodies of influence.
a. Provide training and support as outlined above.
b. Strategize for appointments or invitations to join influential bodies.
This series continues with Part 2: How Quality & Cost Measures Support Effective Consumer Involvement.