From the Chair

Kuchka-Craig Column

Debora Kuchka-Craig, FHFMA

We've heard a lot about hospital-acquired infections (HAIs) lately because Medicare is reducing payments to hospitals with high HAI rates.

If you're like many healthcare finance professionals, you're not entirely sure what your hospital is doing about this issue. But you're confident that your Board and executive team know all about it and are making it a priority. Right? Well-maybe.

In 2009, a study published in Health Affairs showed that one out of four U.S. hospital boards does not regularly look at snapshots of quality performance. Another survey conducted by the Agency for Healthcare Research and Quality found that, at more than half of the hospitals surveyed, quality was not one of the top two priorities when rating the chief executive's performance.

At MedStar Health, we have a number of initiatives under way to enforce a patient safety culture, including simulation trainings, executive team safety rounding, and safety forums. But we also know that accountability for quality needs to start at the top. So several years ago we decided to tie executive bonuses to clinical quality results. Since then, every Board meeting agenda has included an update on quality results. A Board committee now includes representatives from quality and safety committees at each MedStar hospital. And our system's chief medical officer and executive vice president for medical affairs, Dr. William Thomas, recently said that every MedStar executive is now concerned about central-line infections, not only because of the need to improve patient safety, but also because if performance on that metric slips too far, bonuses will disappear.

You may have little or no control over the Board agenda. But if it hasn't happened already, sooner or later, executive leadership will let you know that quality should be on your agenda. I truly admire leaders who are accountable for their own actions and those of their team. But I get extremely frustrated when someone passes the buck or plays the blame game. To me, being accountable is about owning it-the good, the bad, and the ugly. It's easy to share best practices, but much more difficult to share the less common, unfortunate lessons learned. But as uncomfortable as it may be, shining a spotlight on errors instead of sweeping them under the rug has greatly improved hospital care.

Take central line infections. It's an ugly situation. Nearly half of all patients in intensive care units receive central venous catheters, or central lines, because they need intravenous medications, blood, fluid, or nutrition frequently. Infections occur when bacteria grow in the line and spread to the patient's bloodstream. In one out of five cases, it's fatal. The good news is that many hospitals have substantially reduced or even eliminated central line infections by following a simple checklist.HAIs are not a new problem. The Centers for Disease Control and Prevention issued a guideline on this in 2002. The Institute of Medicine identified it as a priority in 2003. And the Joint Commission included it in its national patient safety goals in 2005. What's changed is that the Centers for Medicare & Medicaid Services is making us financially accountable by linking it to payment reductions.

And accountability is the key. As the Institute for Healthcare Improvement put it in their "100K Lives" campaign, "Some is not a number. Soon is not a time." We have the tools we need to meet this challenge. Let's step up and make it happen.

 

Publication Date: Monday, August 02, 2010

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