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and it starts with patient safety. In Ronald
Reagan UCLA Medical Center we give
6-million doses of medications to patients
per year. That’s a lot of opportunities to
make a mistake, so we institute automated
processes and checks to take the element of
human error out of the picture. Hospitals are
also places where there is a risk of infection,
and we institute steps to ensure that our
patients aren’t exposed to that risk. We
borrowed structured communication and
checklists from NASA and the airline industry.
For example, we now have a formal “timeout”
before a surgery where the plan is gone over
and each item on the list is checked off —
things that need to be done every time.
We need 100 percent reliability, and to
do that nothing can be taken for granted.
Beyond not making mistakes, how is
There are some national standards — for
example, a facility should reliably give every
heart attack patient aspirin upon arrival.
What patients care most about, of course,
is whether they survive the heart attack.
So the next level of measurements involves
outcomes. This includes survival rates for
conditions such as heart attack, congestive
heart failure and stroke, taking into account
patients’ risk factors. Transplant outcomes
are also reported for each hospital. But
outcomes for some diseases are not as
easily captured. So we are in the process
of engaging all of our departments in an
effort to define what perfect care looks like.
Obviously safety is essential, but it’s also
explaining treatment options in a way that
helps patients make informed decisions;
having the treatment carried out with the
highest possible technical expertise with
minimal or no complications; and treating
patients with compassion.
In other words, quality encompasses not just
medical outcomes but also what patients
think of the hospital experience?
Absolutely. Clearly, when we talk about
delivering perfect care, it’s what the patient
believes is perfect. Patients expect not to be
harmed; patients expect technically expert
care; and patients expect to be treated with
dignity and compassion. That’s a critical part
of their expectation of high-quality medical
care, so we need to measure that and hold
ourselves accountable in that area as well.
Seven years ago we introduced the CICARE
program to create a standard process for
our interactions with patients and families.
Now we have 8,000 employees who come to
work each day with a desire to go the extra
mile in treating patients the way they would
want their own family member treated.
There are also groups that rank or give
hospitals grades based on quality measures.
How useful are these rankings?
problems, and if they are done badly it
can create misperceptions on the part of
the public. Hospitals and doctors end up
spending a lot of time arguing over what
went into the rankings — energy that should
be spent on improvements. Transparency is
important: If people are coming to me as a
surgeon, they should have access to as much
information as possible about my experience
and performance. But they should interpret
that information carefully and talk to their
doctor about it.
I don’t think those are entirely helpful in
the medical sphere. For one thing, these
rankings are fraught with methodological
Thomas Rosenthal, MD
Vital Signs Spring 2013 Vol. 58