Going to the hospital is a stressful experience. There’s risk involved in any clinical procedure, whether it’s emergent or elective, and that creates understandable anxiety for patients and their families. What if something goes wrong? What if they can’t fix it? What if they find something unexpected?
Such concerns are often answered with reassurance: You’re in good hands. They’re going to take great care of you. You’ll be fine.
No one ever says “Well…you could have one of several different outcomes, depending on where you go and who’s working that day.”
Patients have enough on their mind when they’ve been hospitalized. They shouldn’t have to worry about whether their outcome will be better or worse because of factors beyond their control. But unwarranted clinical variation diminishes quality and patient safety, and adds to overall healthcare costs. Some physicians may bristle at the concept of clinical standardization, but consistent care reduces medical errors—and that’s good for patients, providers, and hospitals.
In part two of our series on hospital quality and safety, ECG’s Tim Babineau, MD, and Kim Adelman, PhD, FACHE, discuss the need to reduce unnecessary clinical variation and why hospital leadership needs to promote a culture of safety.
How does variability impact clinical quality outcomes?
Kim: There’s a lot of variation across organizations. Between hospital A and hospital B, you could have very different patient outcomes. But there’s also variation even within the same hospital or health system, depending on the procedure, the condition, and the providers. And that’s where there’s potential for improvement. Every patient should be confident that they’re going to get high-level care and a high-level outcome. But there is still a lot of variation and not enough consistency.
Tim: I couldn’t agree more. No question there is variation in between hospitals. But the point Kim made about intra-hospital variation is really important. I think patients would be surprised to learn that when you go to a hospital, depending on who your doctor is, who your proceduralist is, who your nurse is, you can have a very different outcome for the for the same problem. Unnecessary clinical variation is the hobgoblin of quality and safety. If there is unnecessary clinical variation, quality and safety suffer. That’s really what we have to get after. We know there are best practices. We know there are best protocols. We need to begin to really reinforce that standardization in healthcare delivery is a good thing, not a bad thing. When I was in medical school many years ago and people talked about standardizing care, we said “that’s cookbook medicine, I’m not going to practice that.” Well, guess what? Standardization improves outcomes. So we we’ve got to get back to that.
How can organizations move the needle on quality and safety?
Kim: It takes the full commitment from the executive leaders to say “we want zero harm, we want zero errors,” and integrating that into every decision that you make, every meeting, every important conversation, whether it’s operational or strategic. Organizations that have a culture of safety anticipate errors and learn from their errors. It requires the entire team, even those people that aren’t clinical. Sometimes the focus is, “What are the physicians doing? What are the nurses doing?” But even your registration staff, your EVS team members, your billers, the administrative assistants that are walking around your facility—it takes all of those people to ensure a safe experience. And that requires a lot of education for everyone across that organization. That’s a big piece of it.
Going back to what we discussed earlier and the imperative to reduce unnecessary variation of care—there has to be real-time monitoring and analytics so clinicians can make shifts in care immediately instead of looking at data from a month ago, three months ago, or a year ago, and then trying to figure out what to do in the future.
And most importantly—having that accountability system from leaders to say this is a priority and fostering a strong culture of safety. You can’t have people be afraid to report issues, transparently share data, or dig into root causes of errors. There has to be a laser-sharp focus on making this better and having a safe place to be able to do that.
Tim: Kim hit on something really important, and it’s this notion of culture. There is such a thing as a culture of safety. Some of my colleagues in the industry don’t love that phrase; I happen to love it. Quality and safety is every single person’s responsibility. It’s not just the responsibility of the chief quality officer.
There’s that old story about when John F. Kennedy visited NASA and asked a janitor what his job was, and his response was, “Mr. President, I’m putting a man on the moon.” He understood that he was part of putting a man on the moon. When it comes to quality and safety, every single person in the organization has to share that same view.
It doesn’t happen overnight. Culture is a really hard thing to change. It has to start at the top. When Kim and I go into organizations that are having some challenges, we emphasize two things. One, this is really hard work. And just as important, the timeline to see the needle move can be fairly long. If you come into an organization and you do a financial turnaround, you might see the results in six or nine months. The progress with quality and safety is measured in years. People often just throw up their hands and say ”Too hard, too long.” But you’ve got to start somewhere. And if it takes five years, you’ll look back and say, “thank goodness we put a flag in the ground five years ago, because look how far we’ve come.”
MORE TO COME: In part three of our series, Kim and Tim discuss the critical role that hospital leadership plays in promoting a culture that prioritizes quality and safety.
Interviewer: Matt Maslin
