Health policy: the UK puts teeth behind quality improvement

Last week's edition of the medical journal The Lancet discusses new quality improvement enforcement efforts that were launched on April 1st. After the BBC reported that death rates were disproportionately high in 25 National Health Service (NHS) administrative areas in the UK, investigations determined that sub-standard care appears to have been responsible for some 4600 excess deaths in those 25 areas between 2007 and 2008. A new law now requires that all hospitals register with an independent health quality monitor, the Care Quality Commission (CQC).  Inspectors from the CQC will visit facilities at least once every two years to review standards and practices. Inspectors will then have the authority to initiate actions that lead to fines, prosecution or even the shuttering of hospitals that do not meet quality benchmarks.

In a sign of how small the health care quality-improvement world is, Sir Brian Jarman is mentioned as a leading contributor to the investigation. Jarman was formerly a senior fellow at the Institute of Healthcare Improvement (IHI), the organization headed by Don Berwick, the new proposed head of Medicare. At IHI, Jarman developed the HSMR, or hospital standardized mortality rate. HSMR measures changes over time in the mortality from conditions that cause 80% of all in-hospital deaths. It has proved a welcome addition to the limited arsenal of measures for assessing hospital quality.

Hospitals facing this new enforcement may want to head the findings published in the current edition of the British Medical Journal. Researchers found that using care bundles, essentially checklists of treatment guidelines, reduced death rates at three London hospitals by nearly 15%. Clinicians addressed the 13 diagnostic areas responsible for 80% of all hospital deaths, including stroke, heart failure and COPD. Use of the bundles reduced HSMR from 89.6% to 71.1% (the lowest among comparable hospitals in the UK) in a year. That's a 14.5% decrease in deaths.

As health policy eyes are glued to the unfolding reform  drama in the US, the NHS deserves applause for lending teeth to its efforts to hold hospitals accountable for their outcomes. Oh yes, and where did the idea of care bundles originate? That's right, another innovation from Don Berwick's IHI. Who would have imagined that something as simple as a check list could be the difference between life and death?

Photo credit: www.nhs.uk