Friday, October 28, 2011

Outcomes research: Embracing Ernest

CONTINUOUS IMPROVEMENT: The MGH’s quality and safety efforts
have come a long way since 1915, when Codman commissioned
this cartoon.

In a 1915 cartoon commissioned by Ernest Amory Codman, MD, an ostrich with its head stuck in the sand satirized his view of the MGH approach to quality and safety. Codman, who joined the MGH surgical staff in 1895, was among the first in the medical field to advocate tracking and acknowledging errors to improve outcomes and famously developed an “End Results System” to monitor each patient’s long-term outcome and classify the causes of poor results. Codman’s ideas were unheard of at the time, and his reported lack of diplomacy alienated colleagues. Frustrated by this resistance, he established his own hospital on Beacon Hill in 1911 and later resigned from the MGH. The true importance of Codman’s work – including his creation of the committee that would become the Joint Commission – was not widely acknowledged until after his death.

Today the MGH has enthusiastically adopted the values Codman championed. Continuous care improvement achieved through outcomes research is embraced by staff throughout the hospital. Specialists in the Edward P. Lawrence Center for Quality and Safety closely monitor, analyze and publicly report outcomes data through a number of venues. A web-based safety reporting system enables employees to share information about errors or potential errors in a standardized and open way. Armed with these metrics, the center helps identify and address areas in need of improvement.

“We have made extraordinary strides in measuring our quality and safety performance,” says Gregg Meyer, MD, senior vice president for the Center for Quality and Safety. “The next step is taking what we’ve learned and applying it. One of the best examples of this work is the MGH Care Management Program.”

In this innovative model of care, nursing case managers serve as liaisons between the patients and their care teams, monitor patients’ progress and needs, and develop customized health care plans. The program has received national attention for its success in reducing hospitalization, emergency room visits and mortality rates – while reducing Medicare costs by as much as 7 percent.

The concept that quality care is efficient care is at the heart of another recent effort known as the Partners Strategic Initiative. Multidisciplinary care redesign teams are sharing ideas across Partners institutions to identify opportunities for improving care and efficiency in specific disease areas or procedure methods. While these efforts may seem clinical, the process of looking at a procedure, determining where it might be improved, trying new options and reporting on their success or failure is the essence of research.

Read more articles from the 10/28/11 Hotline issue.


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