Friday, November 26, 2010

Not Yet Ready for Accountability in Health Care

There seems to be a growing interest in the idea of accountability in health care, but not in the prospect of actually implementing it.

Evidence of the interest is found in the recently enacted Patient Safety and Affordable Care Act (aka health care reform) which makes provision for something called Accountable Care Organizations – entities that include all the major categories of health care providers, including physicians, designed to be capable of being held accountable for the cost and quality of care.

Then I happened to see the November 19 issue of USA Today in which the lead editorial was titled “Preventable medical mistakes take an intolerable toll.” It bemoaned the large number of medical mishaps and deaths due to preventable error.

The editorial went on to suggest three remedies; checklists such as those used by airline pilots, transparency in which hospital safety records are made public, and financial incentives that refuse to pay for patient care caused by medical mistakes.

But there was no mention of holding anybody accountable.

When Paul O’Neill was CEO of Alcoa, the aluminum company, he took on the goal of eliminating industrial accidents within that company. He reports that in so doing, he proceeded on the assumption that every industrial accident in Alcoa was his fault. He established and implemented protocols that brought every such accident to his attention and required that immediate steps be taken to identify the root causes and implement remedies to keep it from happening again.

When developing its editorial, USA Today might easily have contacted the CEOs of several hospitals, asking them, for example, about the extent to which surgery checklists were being used in their hospitals, inquiring as to the reasons for any lack of use, and then quoting those interviewed by name.

That would be holding somebody in health care accountable. I find it interesting that either it did not occur to anyone at USA Today to do that (though it did publish a companion editorial on the same subject by the CEO of the American Hospital Association) or those responsible thought it would be impertinent to do so.

Either way, it seems as though we are at a point at which it is OK to talk about accountability so long as nobody does anything about it.

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