Tuesday, October 16, 2007

Still Nobody’s Business

“US children get needed healthcare less than half the time, study finds”

That was the headline of an Associated Press article that appeared in the October 11, 2007 issue of the Omaha World Herald.

The article was a report of another one that had appeared that same day in the New England Journal of Medicine authored by a group of researchers from the Seattle Children’s Hospital Research Institute. The Institute is affiliated with the University of Washington, where its staff members hold academic appointments.

The summary at the beginning of the NEJM article ended with the following sentence:

“Deficits in the quality of care provided to children appear to be similar in magnitude to those previously reported for adults. Strategies to reduce these apparent deficits are needed.”

What strategies might they have in mind? I wondered. On that subject, the article was silent other than a statement at the end of the introductory summary that “Leaders must recognize that the current system does not meet children's needs and must take action. ‘
The same issue of NEJM had an editorial by James M. Perrin, M.D., and Charles J. Homer, M.D., M.P.H. from the Harvard Medical School/Massachusetts General Hospital Department of Pediatrics in Boston, MA and the National Initiative for Children's Healthcare Quality in Cambridge, MA. Here is what they had to say about the findings reported in the NEJM article:

“Their observations are shocking: the right services appear to be carried out less than half the time. Services are not delivered when they should be, or they are delivered when they should not be.”

“Improvement of the performance of the children's health care system will require systemwide change; entreaties to hard-working and deeply caring pediatricians, family physicians, nurses, and hospital staff to work harder and care more will not succeed by themselves. Effecting change will require leadership across all levels and systems involved in children's health care and a wholehearted commitment by those who deliver care, pay for care, and receive care. Leaders must recognize that the current system does not meet children's needs and must take action.”

So both the article and the editorial state that this problem should be addressed by “Leaders.” It raises the question of which leaders they have in mind. They didn’t say. It reminded me of the old adage that what’s everybody’s business is nobody’s business.

That isn’t good enough. If we are serious about making progress in dealing with the problem, we have to make it the business of somebody specific; like, for example, the trustees and executives of Seattle Children’s Hospital and the Massachusetts General Hospital. Both of those institutions are involved in providing healthcare to children.

Doing the study, reporting its results, and viewing the results with alarm are all good and the authors are to be commended.

Now what we need is for the executives of the institutions they represent to do something about it. Nobody’s business needs to become somebody’s business.

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