Turning quality and safety into a science

  | March 6, 2017

In May 2016, Johns Hopkins University researchers published a paper in The BMJ claiming that medical errors — undercounted by the Centers for Disease Control and Prevention — should be considered the third-leading cause of death in the country.

Those errors occur because "healthcare was never designed for quality and safety," says Donna Woods, a professor of pediatrics at Northwestern University. The university recently created the nation's first Ph.D. program and doctoral degree in healthcare quality and patient safety.

As large health systems attempt to corral their physician networks into a cohesive whole — and control costs — quality and safety have become an increasingly pressing concern. athenahealth's research into high-performing medical organizations, an ongoing project to find the capabilities that drive financial and clinical success, has found that top performers develop standardized clinical protocols to optimize care, documentation, and safety.

But often, when quality and safety initiatives come from within organizations, they aren't shared with the broader industry, says Woods.

“In your institution, you are figuring out what to do and stumble on something that cuts adverse events," she says. “But the hospital down the street or across the country wouldn't learn that. So it is important to generate results and to publish and disseminate widely."

Woods cites the Keystone Project, a collaborative effort among hospitals in Michigan, as an example of a successful shared research project on quality and safety. The study found that catheter-related blood stream infection rates could be effectively dropped to zero with a few standardized procedures, from hand washing to cleaning patients' skin to removing unnecessary catheters.

“Prior to that study, it was thought by most clinicians to be not preventable," Woods says. “We need research [like that] to determine what the best interventions are and how they can be more reliably implemented. We don't expect people to sit around a table, which is how quality is often done now. We need research. Going on hunches is not enough."

Instructors in Northwestern's Ph.D. program include engineers, psychologists, and risk assessment and change management specialists who teach students to identify holes in the healthcare system and then conduct the research that supports appropriate fixes. The students are taught qualitative and quantitative research skills in the area of quality and safety.

“It is more akin to engineering," Woods says. “We teach human factors, management change and operations strategy. Cognitive psychology. There are predictable ways that people err."

The curriculum also covers teamwork and communication among primary care physicians and specialists as a patient moves through the system. As one example, students are asked to write instructions for a man from Mars on how to make a peanut butter and jelly sandwich. Usually, when the professsor attempts to follow their directions, what's created is nothing like a PB&J.

The lesson learned is that healthcare professionals make cultural assumptions, and those from other cultures may not understand their instructions, leading to medical errors.

Northwestern's program is designed for senior and mid-career clinicians and healthcare professionals. The first graduate was Cindy Barnard, vice president of quality for Northwestern Memorial HealthCare; her research involved asking patients how they define quality healthcare.

Woods says she hopes the students' research will be published and applied throughout the healthcare system.

Other institutions have recently created master's degree courses in quality and safety, including George Washington University, Thomas Jefferson University's College of Population Health, University of Illinois, and Cornell University.

“Success," she says, "would be lots of programs like this generating skilled researchers in this field."

David Levine is a regular contributor to athenaInsight.

Turning quality and safety into a science