David P. Lind | President, Heartland Health Research Institute
The Idea: Radically change and improve how health care is safely delivered to Iowans, by embracing three bold approaches to ensure we have reporting, transparency and accountability when medical care is delivered to our citizens.
Des Moines has a vibrant medical community with many capable doctors, clinics and hospitals. Accordingly, it could become a model for the entire state and the country by instituting transparency and safe care practices to reduce medical errors. But first we need to break through the status quo bias and recognize that safety in medical care in Des Moines (and Iowa) needs improvement.
Medical errors are events of health care-induced harm and death, most often involving basic human and system errors. There is currently no mandatory reporting system for medical errors in Iowa and no centralized and effective way for patients to research their doctor or hospital before choosing to receive care.
Why is this acceptable? Rigorous safety reporting is required by airlines, yet when we are at our most vulnerable because of illness, we have no way to determine which provider has the best safety record. Why should we feel safer boarding an airplane than walking into a hospital or clinic?
Our recent Iowa study revealed that roughly 1 in 5 Iowans (20 percent) have experienced medical errors in their treatment, or the treatment of others close to them, within the last five years.
To illustrate this, consider that the Des Moines metro population is approximately 683,000. If all residents seek medical care during a five-year period, statistically about 137,000 patients could experience medical errors. Additionally, our study showed up to 60 percent of those errors could have serious consequences.
The study further disclosed that 60 percent of those who experienced a medical error were not told by their provider that an error occurred. An overwhelmving 90 percent of respondents said health care providers should be required to inform a patient when an error occurs, and 93 percent agreed that the public should have access to medical error information.
The Des Moines medical community should heed these concerns, adopt policies notifying patients of any medical error and report that error to a centralized information repository. By shining a light on this important health crisis, errors can be examined and reduced by implementing processes that minimize them. Pretending they don’t happen benefits no one.
Patients want to trust their doctors and hospitals, and transparency is a huge factor in promoting that trust. Everyone understands that accidents happen. We are all human. However, when medical errors happen frequently, insurance companies unknowingly pay for the resulting complications.
Therefore, health insurance premiums continue to rise and everyone suffers – not just the patient harmed by the medical error. Some say this issue is just too hard to tackle. But if we don’t begin, all Iowans will continue to suffer one way or another.
Here is a three-pronged approach to consider. Des Moines can become “greater” by serving as the example for an eventual state-based infrastructure that implements three approaches:
- Initiate mandatory – not just voluntary – provider reporting of medical errors. State mandatory compliance will require legislative action and approval by our governor. Safety of our citizens should not be viewed through a partisan lens.
- Create a simple and secure third-party central repository for patient reporting of medical errors that augments provider reporting and may determine whether the medical care is properly billable. The repository could be established and operated through a joint public-private collaboration operated by an independent organization. This radical thinking is actually quite logical. Do we pay for damaged products elsewhere without requesting a refund? We don’t. Why should health care be an exception?
- Insurance companies in Iowa can implement initiatives to ensure their clients are safe while obtaining care in the Des Moines area (and beyond). This can be done by developing an ongoing, independent, randomized-sampling process to survey insured patients (and family members) who recently obtained care. Critical insight into the prevalence and types of medical errors that occur would allow for future improvements. Success must be defined and tracked. As major purchasers, area employers can insist their insurers promote safe care in this way.
Public dissemination of results is paramount to moving transparency efforts forward. These approaches are not intended to shame medical providers, but rather to provide a means for all providers to learn from patients and institute changes to prevent future errors. Radically improving patient safety requires meaningful collaboration between providers and patients and between hospitals and the communities they serve.
I believe the Des Moines medical community genuinely cares about their patients. So why not give their constituency what they want – a model of transparency and safety? Be bold, Des Moines, and lead the way into greatness! >
