Friday, May 18, 2007

A Step towards Reform

While everyone is bemoaning the need for health care reform, it is going on as we speak.

Among the most important barriers to reform has been the division of health care into institutional (e.g., hospital) and professional (e.g., physician) sectors. While they are, in practice, indivisible, neither has taken responsibility for the other. The result has been an absence of accountability for performance. Without accountability, reform became very difficult because no one had responsibility for doing it.

That is changing.

In an article titled “Hospitals tie CEO bonuses to safety” (The Boston Globe, May 5, 2007), reporter Christopher Rowland points out that about half of the non-profit hospitals in the U.S. are now including patient safety in the criteria for awarding performance bonuses to their CEOs. Safety factors include checking of patient IDs, tracking tissue specimens, cross-checking medications, and hand washing.

This development marks a huge shift in the culture of health care. In the past, safety issues such as these were considered clinical matters in which direct administrative involvement was taboo. Administrators could urge their professional staffs to address them, but going further than that was to put their jobs at risk.

The next step will be to hold administrators accountable for clinical outcomes. It, too, will be large one. But it will be easier than making them accountable for safety now that the barrier against administrative involvement in clinical matters has been breached.

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