Ten years ago, the Institute of Medicine report To Err is Human: Building a Safer Health System demonstrated that up to 98,000 patients die in United States’ hospitals each year as a result of avoidable medical errors. With this mortal diagnosis for health care delivery, how can it be that subsequent meetings of the American College of Healthcare Executives (ACHE), the executives responsible for health care delivery institutions, continue to focus primarily on their leadership development and self-promotion? As the Obama Administration rolls out health care reform, can we hope for a harmonic convergence in the alien worlds of health science and practice?
Astrological alignment of sun, moon and stars is often used to explain events where systems are cleansed and false or damaging separation between related structures crumbles to the betterment of the global system. Why the need for such a powerful policy event to result in a global perspective of the problems and solutions to better health?
As a recovering health care administrator and newly ordained health policy researcher, I can contrast many aspects of the health science, policy and delivery solar system, concluding that the difference may be in their approaches to finding the truth and facts that guide their work. The metrics for failure are the same; avoidable death and suffering can be measured and should be avoided. These sentinel events occur on the watch of health care executives and as the ACHE example suggests, health policy reform will be hindered until health care executives demonstrate greater sensitivity to societal needs and have both tools and incentives to address societal benefit. To demonstrate the chasm, contrast the agenda of the upcoming American Society of Clinical Oncology meeting, where the focus is on novel research on personalized cancer treatments, to the recent statement of the American Hospital Association on Senate health care reform proposals, where the priority is self-serving provider reimbursement.
Peer review is not without problems of internal politics and sometimes lack of public value consideration, but I wonder if health care delivery wouldn’t benefit from a system like this (or maybe better than) found in the science and policy research community. Subjecting my work to the scrutiny of experts in my field was something I learned as a researcher, an eye-opening experience after years as a health care executive where my charge was not knowledge creation but cost cutting and market share. The opportunity is now both exciting and frightening. It is thrilling to present my assertions about best practices in health care. But that they are scrutinized in peer review processes provides a new and frightening level of accountability. This makes me think that health care delivery executives have no comparable peer review system. Perhaps they could benefit from one. Certainly peer review in health care delivery requires major policy changes, as tort and health information protection laws limit and often make scrutiny of this type illegal. But as we enter an era of major health care reform, is that any excuse? I think not.
I was recently asked to review a plan for expanding the research enterprise at a children’s hospital. The science resources are comparable to children’s hospitals throughout the country with researchers renowned for their breakthroughs, each year publishing thousands of scientific journal articles and securing many millions of dollars in National Institutes of Health funding. Health care administration is the best of the best, having developed well-reimbursed, endowed and award-winning facilities and services. Yet clinical research has been slow to develop there because the healthcare executives “couldn’t make the clinical research business plan work.” The basic research development speeds along, supplemented (when it works well) by the peer review process. So where is the comparable peer review system to promote development of best clinical research practices and resources in the hospital? Participating in conference calls on the project, I heard emphasis by the executives on limiting access to data, forming politically correct statements on why services were not already available, and lobbying for additional funds from the state legislature. So my question…where was the peer review process at the health care delivery level to promote accountability for the system to change for the sick kids?
The health community shares a vision of a healthy world at an affordable cost. Can we incentivize a peer-review type approach to accountability in health care delivery, and can we remove legal barriers to discussing why the current delivery system is failing? If not, then health care reform is more likely to enter a black hole than trigger a harmonic convergence.
