Focusing on Patient Safety in South Carolina

Susie Robinson & Amanda Hobbs, President and Vice President, Clemson University IHI Open School Chapter

The 5^th annual SC Patient Safety Symposium, held April 25 in Columbia, SC, proved to be a valuable experience for both of us! We learned a lot about patient safety and had the opportunity to her many leading experts in the field.

(We would first like to thank the South Carolina Hospital Association (SCHA) for sponsoring our attendance and for its constant support of the IHI Open School Chapters in the state of South Carolina.)

Here’s a rundown of our experience:

-          We kicked things off by meeting with leaders within the IHI Open School community, including the members of University of South Carolina’s IHI Open School Chapter and our two Southeast Regional Coordinators. 

-          As the Symposium began, we took front row seats and listened to Maureen Bisognano, CEO of the Institute of Healthcare Improvement.  She first recognized our state for the strides South Carolina has made in decreasing health disparities between populations, especially in Columbia.  Bisognano spoke briefly about the Triple Aim and recognized areas for health care improvement.  Bisognano then introduced Regina Holliday, a painter and patient advocate who painted representations of both the provider and patient perspective throughout the conference.

-          Next, Dr. Atul Gawande spoke about the future of Safe Surgery 2015, and the progress of South Carolina as a pilot state. 

-          After a short break, Dr. Eric Coleman from the University of Colorado spoke about the Care Transitions Program.

-          At lunch, the few students in attendance were recognized and the Lewis Blackman Patient Safety Awards were presented to honor deserving individuals from around the state. (The lunch, accompanied by the South  Carolina Philharmonic Orchestra, was delicious.)

-          As our day wrapped up, we were fortunate to spend some time talking with Maureen, Dr. Rick Foster, SCHA Vice President of Quality and Patient Safety, our IHI Open School Regional Coordinators, and patient advocate Helen Haskell (Lewis Blackman’s mother). 

We are grateful we had this opportunity through our involvement with IHI Open School!

IHI CEO Maureen Bisognano poses with faculty and students
at the 5^th Annual SC Patient Safety Symposium in Columbia, SC.

Costs of Care Essay Contest!

Medical bills are a leading cause of personal bankruptcy and health care providers decide what goes on the bill.

According to the Congressional Budget Office, the United States spends $700 billion dollars each year on tests and treatments that do not measurably improve health outcomes--a figure comparable to our total spending on the Iraq War. And here is where things become truly awkward: few providers understand how the decisions they make impact what patients pay for care.

Let's recap. Medical bills are bankrupting Americans, providers decide what goes on the bill ($700 billion dollars of which might not need to be there), and providers rarely have information about what things cost. That seems like something we ought to fix, doesn't it?

If you agree and have a story to tell about it, there could be $1000 in it for you. Remember a time you got a medical bill that was higher than you expected it to be? Or a time when you wanted to know how much a test or treatment might cost and couldn't find out? Costs of Care, a Boston-based nonprofit, is offering $1000 for short anecdotes illustrating the importance of cost awareness in medicine. We want to hear your story.

The submissions will be judged by a high profile crew of policymakers, doctors, and journalists that include Atul Gawande, Michael Dukakis, Jeffrey Flier, Michael Leavitt, and Tim Johnson. Submissions will be due by November 1st to contest@costsofcare.org. Additional details are available at www.costsofcare.org/essay

Dr. Neel Shah is the executive director of www.CostsOfCare.org, and a resident in Obstetrics and Gynecology at Brigham & Women's Hospital in Boston.

How Do They Do That? Low-Cost, High-Quality Care in America

In middle school, the goal was to be cool. Picking out the misfits was easy. They were the ones who carried tons of books, wore clothes that never seemed to fit well, and had no idea that "Baby One More Time" was a song sung by the newly popular Britney Spears. I was one of those. I spent an embarrassingly great amount time studying how to become cool and decided that being cool meant knowing exactly what was "in" and having a cool attitude. How did I come to this conclusion? I picked out some of the coolest and most popular kids at school and asked, "How Do They Do That?"

Just yesterday, Atul Gawande, Don Berwick, Elliott Fisher, and Mark McClellan, published an Op-Ed in The New York Times. In the Op-Ed, the four weigh in on the current health care reform dialogue: raising taxes or rationing care in order to expand coverage and control the rising, nation-crippling health care costs. The take home message of the Op-Ed is that raising taxes or rationing care are not the only alternatives to achieving health reform. Why not try redesigning how health care is delivered so that it is both low-cost and high-quality?

This is the same situation as the misfits in middle school striving to be cool. What we as a nation need to do is identify these high-performing examples and ask, "How Do They Do That?"



This is an exploration that Atul Gawande, Don Berwick, Elliott Fisher, and Mark McClellan have already started. Data from The Dartmouth Atlas, a research initiative hosted by The Dartmouth Institute for Health Policy and Clinical Practice that uses Medicare claims data to document variations in how medical resources are distributed and used in the United States, was used to identify these high-performing examples. Out of the 306 Hospital Referral Regions (HRRs), regional health care markets for tertiary medical care, across the US, 74 high-performing regions were identified. (Click here to see the Medicare spending in your HRR). What does high-performing mean? These regions have per capita Medicare costs that are low or markedly declining in rank and have above average quality based on federal measures.



Out of these 74 high-performing HRRs, teams of hospital executives, physicians, and local leaders from 10 geographically different regions were invited to Washington, D.C., on July 21st to tell us, "How Do They Do That?" These HRRs included: Asheville, North Carolina; Cedar Rapids, Iowa; La Crosse, Wisconsin; Sacramento, California; Sayre, Pennsylvania; Portland, Maine; Everett, Washington; Temple, Texas; Richmond, Virginia; and Tallahassee, Florida.

The stories these 10 teams shared with us that day were truly remarkable. If the other 232 HRRs could perform like these high-performing examples, we'd be in good shape.

The most interesting finding of the day was that there is not just one way to become a high-performer. Some of these HRRs have one dominant health system where physicians are salaried (Scott and White Hospital and Clinic), while other HRRs had highly competitive systems sharing the market (Sacramento, CA).

Some of the major themes from the day were using data to inform change (The Op-Ed specifically refers to the number of CAT scans in Cedar Rapids), using lean/six sigma and other waste reduction/process improvement strategies in their daily operations, creating strong community ties and being accountable for the health of the region, training and creating opportunities for physician leadership, building a patient-centered culture, and continuous improvement. All of the HRR teams were surprised to find out that they were high-performers and acknowledge that they still have plenty of room for improvement.

Now that we've found these great examples, the cool kids of the health care middle school, we need to continue to ask, "How Do They Do That?" and follow their lead in redesigning health care to create a high-performing and healthy nation. Doesn't that sound like a great alternative?

Patients Take Center Stage in Gawande's Writing

It's been nearly three weeks since Atul Gawande's article, "The Cost Conundrum," was published in The New Yorker. But the buzz and excitement has not even begun to dwindle. On the contrary, my friends who never paid any attention to health care are now asking me questions like, "So, what's with the health care costs in the US?", "What is Obama talking about?", "Dartmouth Atlas? What is that?", "Is the US going to get universal health care?", "Can we fix the incentives to reduce waste?", "Is the overuse mainly a result of practices of defensive medicine?"...

To all of my friends who have asked me questions, thank you and keep them coming! As a very soon to be medical school student, I care a great deal about health care. While I understand everyone has their own passions, it has always surprised me by how little people cared about a system that everyone has had experience with. But, thanks to Atul Gawande, I now have an excuse to blabber on ad nauseam about health care to all!


Word Cloud from Atul Gawande's "Cost Conundrum" piece


Word Cloud from Atul Gawande's University of Chicago Pritzker School of Medicine Commencement Address

Why the sudden shift in interest? The facts that Atul Gawande is a eloquent and powerful writer, Obama has made Gawande's article mandatory reading for the White House, and that it's all over the news are important factors. However, for the first time, I think the health care reform agenda is being painted in a new light. Sure, insurance and coverage are still big topics; but there are new ideas being tossed around like quality, patient-centeredness, culture of medicine, and team work. Just take a look at the word clouds of Gawande's pieces!

Most importantly, patients are now a big part of what many see as the pathway to a better health care system. What do patients need and want? How can we as health care providers and engineers of the health care system provide better care for the patients? Since we are all going to be patients at some point in our lives, these arguments hit a very personal chord. Hopefully, as we continue to search for the best health reform plan, we can all dig deep and remember the true purpose of health care and let that notion guide us.

Thanks to Ben Tseng for sending me this piece in the Washington Post with the Gawande word clouds. These images are all too powerful!

Here is another great related Atul Gawande piece that focuses on quality: "The Bell Curve" published in The New Yorker.