It seems as if they spring up every day: new web sites, rankings and listings to help patients find the “best” hospital and the “best” doctors. But U.S. hospitals are not subject to federal regulation, unlike in many other countries, and the only national oversight comes from Medicare and the Joint Commission, a nonprofit group which accredits and sets safety goals for 17,000 hospitals, a monumental task. So patients depend mostly on the hospitals themselves, which have their own internal safety and quality supervision, for answers.
At Massachusetts General Hospital, that effort is led by Gregg S. Meyer, MD, MSc, senior vice president of the MGH/MGPO Edward P. Lawrence Center for Quality and Safety. Dr. Meyer and his staff conduct reams of internal audits on everything from the speed with which pneumonia patients are given antibiotics in the emergency room to the rate of patient falls. Results of the investigations are posted on the MGH web site, with comparisons to national benchmarks.
So what quality and safety measures should patients care about? Mass General Magazine sat down with Dr. Meyer to find out.
Q: Why does transparency matter?
A: When you buy a car, you know what to look for, but in health care it’s not so clear. Hospitals have an added burden: to find data, put it into context and educate people about what’s important. For example, contracting an infection during the course of care is a concern for any hospital patient. We know that improving caretakers’ hand hygiene matters in preventing the transfer of infection. Our web site, www.qualityandsafety.massgeneral.org, posts our hand-washing data and our infection rates, with the bacteria of chief concern in hospitals being MRSA (Methicillin-resistant Staphylococcus aureus).
We started an aggressive hand hygiene campaign in 2002, and compliance rates have since skyrocketed. MRSA rates were also cut in half, despite a two-fold increase in the number of patients who arrive at MGH with a MRSA infection.
We’re also constantly collecting data on heart attack responses, medication safety systems, therapies for pneumonia, antibiotics administered in conjunction with surgery and smoking cessation counseling.
Q: How do you measure physician performance?
A: We are collecting data on medical errors and other indicators of performance, but we’ve found that with performance, the personal stories from patients often give us our best insights. So we are doing patient surveys and are feeding the results back to the providers. For instance, “Dr. X didn’t explain the side effects of the medicine very well.” That type of feedback will help Dr. X improve his patient care. Right now, we are focused on finding ways to systematically get that feedback into the hands of providers and developing programs to foster improvement in care.
Q: What other kinds of things you do as an internal auditor?
A: Our mantra is: If you don’t measure it, you can’t improve it. Recently, we’ve made substantial improvements in pulling data, taking surveys and providing measurements We ensure that we hire and retain superb professionals.
We train our patient care leaders, frontline staff and residents to be able to speak with patients about medical errors and to investigate the root causes of those events. We are always trying to improve communication between caregivers about patient cases, as they hand off patient care. Communication can be a problem in any major medical center that has lots of moving parts. If we identify a communication problem, we bring the staff team to the state-of-the-art Center for Medical Simulation at MIT, which helps them see where things could slip through the cracks. We are setting up patient-family advisory councils. So far, we have these groups in our cancer, pediatric medicine and cardiology divisions. They meet regularly with administrators and clinicians and provide opportunities for patients to be integrally involved in their own care.
Finally, we solicit feedback from our own employees — and they don’t pull any punches! They told us, for example, that we need to include patients’ ideas when we design our clinical facilities, and we used those ideas designing the Building for the Third Century.
Q: What’s the most important question a patient could ask about a hospital’s quality and safety standards?
A: Whether the hospital has electronic health records (EHR) and whether the clinicians use them. We are all safer, for example, when a doctor can log onto a computerized system to get the data needed to make the best clinical choice, check for interactions and allergies and send a prescription to the pharmacy electronically. At MGH, we use EHR and are working to make the system better in terms of functionality and usability.