Health Agencies Toil to Track Medical Errors, Improve Patient Care

NEW YORK CITY, May 8 -- The Institute of Medicine shocked the nation in 1999 by reporting that 44,000 to 98,000 hospital patients die each year due to medical errors. A subsequent Institute study in 2001 concluded that the entire health care system needs to be redesigned to repair quality problems.

With the results of these reports fresh in their minds, four leaders from New York medical institutions convened Monday night at The New York Academy of Medicine to discuss improvements that have, and have not, materialized. The Academy's Section on Health Care Delivery and the Division of Health and Science Policy organized the event, called "Strategies for Crossing the Quality Chasm."

Ronda Kotelchuck, Executive Director of the Primary Care Development Corp. (PCDC), told the 60-person audience that health centers funded by her organization were begun with the goal of expanding access to care citywide. (PCDC secured $100 million in financing for 28 new primary care centers in the city's poor, underserved communities since 1994.)

But her organization realized that access to care does not guarantee quality. To ensure that patients receive the level of service they deserve, teams of staff members participated in six- to 12-month training sessions constituting an "operational overhaul," Kotelchuck said. The results? Patients' wait times dropped dramatically, doctors were able to see more patients, marketing efforts improved, clients increased by 14 percent, and revenue grew, Kotelchuck said.

Pinpointing and repairing problems can be quite difficult in a sprawling hospital system such as the New York Presbyterian Health Care Network, said Dr. Eliot Lazar, the Network's medical director. The mammoth system includes 30 hospitals with more than 9,000 beds.

Lazar explained that New York Presbyterian adopted a "System Standard Initiative" that has made it easier to gauge performance of hospitals and doctors, identify problems, and track the success rates of medical procedures at different hospitals. This has led to important findings.

For example, the tracking system revealed that state-led disciplinary actions against physicians occurred four times more often at one hospital than the median rate.

"We determined this hospital clearly had issues in terms of its medical staff governance," Lazar said. That gave administrators the information they needed to take corrective action. A new chief medical officer was recruited.

Karen Smoler Heller, Executive Director of The Health Economics and Outcomes Research Institute at the Greater New York Hospital Association, cautioned that hospital report cards can sometimes be misleading. Some quality report cards do not take into account that patients who died may have entered the hospital with complications that placed them at higher-risk, she said. That can paint a facility as a poorer-performer than it really is. Heller described the Institute's efforts to improve measurements of patients' risk factors, which will lead to more accurate comparisons of hospitals' performance.

That said, Dr. Stephen M. Schoenbaum, Senior Vice President of the Commonwealth Fund, explained that hospitals still have many shortcomings, including uneven quality of care, understaffing, inadequate knowledge or skills among staff, and poor coordination of care.

Schoenbaum blamed the deficiencies on a variety of factors. Complexity of care is increasing faster than quality adjustments, he said. Like all humans, doctors are imperfect: even those who averaged "95" in medical school, were wrong 5 percent of the time, Schoenbaum said. Finally, there's the "frog in the pot" conundrum. Place a frog in cool water and bring the water to a boil, and the frog will stay put until he boils to death. That's because he adjusts to gradual change. Throw the frog in a pot of hot water, on the other hand, and he'll immediately jump out.

Those who administer the nation's health care system are like the proverbial frog in the cool-water pot.

"We've been living with it for a long time," Schoenbaum said.

The New York Academy of Medicine is a non-profit organization founded in 1847 that is dedicated to enhancing the health of the public through research, education and advocacy, with a particular focus on disadvantaged urban populations.

Posted on May 8, 2002

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Andrew J. Martin
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The New York Academy of Medicine
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