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Quality Matters: Harbingers for the Future


Quality Matters: Harbingers for the Future - First, HCFA now has our first full time staffer, Deborah Wachenheim, working on quality. She’s got a full plate, and one of her first missions is to develop a Massachusetts Consumer Health Quality Council to create a bonafide consumer voice on quality, medical errors, and patient safety. We’re looking for regular consumers who want to understand this arena and work as consumer voices to make a real difference. Setting this up has been a passion of mine since arriving at HCFA in 2003. You can reach Deborah at dwachenheim@hcfama.org.

Second, this was the week the new Quality and Cost Council, set up under the MA health reform statute, held its first meeting. See Thursday’s blog by Deborah for a first person account. We’ll be continuing these accounts just as we’re doing for the Insurance Connector meetings. Setting up the Council was first proposed in the ACT! coalition’s legislative filing in December 2004. We’re happy to see it off the ground. We’re not sure what will come out of, and we’re disappointed the Legislature relegated consumer representation to an advisory committee and not to the full Council. We think this is an early signal that quality AND cost will be front tier issues in 2007 and 2008.

Third, the federal Agency for Health Care Research and Quality has posted an interview with Dr. Lucian Leape of the Harvard School of Public Health, and if you care about quality, this is a keeper. Lucian is a pediatric surgeon who invented the notion of “error in medicine” in a seminal JAMA article in 1994. He’s a fantastic resource and treasure to have in Massachusetts, and I highly recommend this interview. Here’s a tidbit:

RW: As I was reading your apology document, I was struck by the clear statement on the first page, that this is not about a business case, it’s a moral and an ethical case. How do you see the relative role of these two types of motivations in terms of the overall safety movement?

LL: On the apology front, I’m very concerned that people put too much emphasis on the fact that this may reduce your chance of being sued. I happen to think it will, but I don’t think that’s the reason to do it. I’ve been struck by the fact that openness, transparency, and full disclosure and apology when indicated is not only an essential part of treatment for the patient, it’s also an essential part of treatment for the doctor or caregiver. And I don’t think that case has been made. Because when you’re not open and honest with people, you’re lying. And lying corrupts your own integrity. So honesty, transparency, and apology are just as important for the doctor as for the patient.

But the primary reason to do it, of course, is our obligation to the patient. We need to think of it as a form of treatment. The patient has a serious medical condition: an incipient loss of trust, and emotional turmoil because of what’s happened. We need to do what we traditionally do, which is to think of what’s in the best interest of the patient and prescribe and carry out that therapy. My hope is that if we can frame it that way, then we can help physicians recognize the importance of doing it. A side benefit is that they will indeed be much less likely to be sued and, if they are sued, the payments will be much less. But that’s not the primary motivation.

So many writings about Quality Matters: Harbingers for the Future, hopefully it can benefit us all, greetings Pororomo stay healthy and live the routine as usual.

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