Quality and Public Trust / by Joe Furia

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At a recent conference, I was asked to comment on the most important policy advancement in Arizona over the last decade. It was intended to be an entry into a discussion of our progress in healthcare access and coverage, particularly through the restoration of Arizona’s Medicaid program. 

There’s no denying Medicaid restoration is a healthcare success story – a monumental achievement that has improved access to affordable care for hundreds of thousands of our Arizona friends and neighbors. But there’s another element to consider when evaluating the progress of our healthcare system – one that, for me, is just as important.

I’m talking about quality. 

For decades, polling of public attitudes toward our healthcare system has overwhelmingly yielded the same answer: cost is the greatest problem; access is the greatest concern, and quality is the greatest strength. 

I agree with the consensus that rising cost is the biggest problem in healthcare – we can and must do better to control expenses. Similarly, access remains a primary concern to anyone facing a diagnosis or injury that requires healthcare treatment, notwithstanding major improvements over the last decade. 

It is in that area of quality, though, that a much more honest conversation is needed. To be sure, our country is fortunate to have some world-class healthcare providers, and there have been amazing innovations and medical breakthroughs within my lifetime. But the “dirty little secret” in healthcare has long been that, too often, things go wrong.

This issue was thrust before the public with the 1999 release of the Institute of Medicine’s eye-opening report, “To Err is Human.” Among its findings, the study asserted that as many as 98,000 deaths occur in America’s hospitals each year as a result of preventable medical errors.

The healthcare field initially disputed the data, but over the past 20 years has come to accept the underlying reality. We also had to recognize the problem is not due to bad actors – the healthcare field is filled with highly competent, caring and committed healthcare professionals. Instead, the problem is that good people are working in bad systems that need to be made safer. 

For me, one of the most remarkable healthcare stories of the past two decades has been in our response to this issue. While there is always work to be done, fundamental improvements have been made to patient safety that has brought our healthcare system to a place much more deserving of the public’s trust. 

Arizona is among the states where this progress has been most notable, and the Arizona Hospital and Healthcare Association has played a leading role. For example, in 2006, Arizona hospitals led early efforts to implement a statewide, uniform system of color-coding patient wristbands to help workers better identify at-risk patients – including those with do-not-resuscitate orders, allergies, or who are most vulnerable to falls. Since many healthcare workers practice at more than one hospital, standardized wristband colors help reduce confusion and possible medical error. 

Similar leadership efforts continue to this day, including here at AzHHA. In the last few years, we have tackled an array of major hospital quality problems, such as catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI). Most of our focus has been aimed at reducing all-cause harm through the Partnership for Patients initiative. Through this work, participating hospitals have prevented nearly 1,000 patient harms since October 2016 for a total estimated cost savings in excess of $10 million.

A recent ranking of state healthcare systems puts Arizona at 16th in the nation in terms of quality. Meanwhile, the same report lists Arizona 43rd for healthcare access. 

These numbers speak both to our progress and our need to do more. Our vision of Arizona as the Healthiest State should push us to be No. 1 in all measures of healthcare. High on our to-do-list are major quality-focused initiatives, including improving end-of-life care through education and patient empowerment, as well as early identification and treatment of sepsis, which has a 10% or higher mortality rate, is often preventable and remains one of the leading causes of death in American hospitals.    

In considering Arizona’s biggest recent healthcare successes, there’s a strong case to be made for our work to ensure the safe and quality care of Arizona patients, people and communities. Here at AzHHA, we look forward to celebrating that progress during our upcoming Patient Safety Awareness Week (March 11-17), while reaffirming our commitment to do even more.