In just one decade, the Institute of Medicine has changed the landscape of American healthcare with its consecutive reports To Err is Human: Building a Safer Healthcare System in 1999 and Crossing the Quality Chasm: A New Health System for the 21st Century in 2001.1,2 These reports presented a vision and agenda for how healthcare needs to be radically transformed in order to meet the six attributes of ideal care: safe, effective, timely, efficient, equitable, and patient centered. This vision is easy to agree on yet hard to implement, and hospitals across the nations continue to struggle to create an intelligently and effectively designed system in what was once a “systemless” array of professional autonomy, nonstandardized practice, and free enterprise.
The leaders of academic medical centers (AMCs), with their competing missions of education and research, face additional challenges compared to their non-AMC colleagues, because such vast improvements in the safety and delivery of patient care cannot be achieved without prioritizing the safety and quality mission in parallel with the research and educational mission.
The Future of AMCs
Given the importance of these issues, a study published by Keroack and colleagues in Academic Medicine is notable for calling attention to the challenges AMCs face in the future.3 This study represents the first attempt to quantify, through a composite score of a wide variety of patient-level data, the quality and safety of care delivered in AMCs. In addition, the authors augmented their score by performing blinded site visits to validate their patient-level data with experiential observations and interviews. Such qualitative data allowed them to identify organizational themes that separate the high-performing from the low-performing medical centers. These data can help leaders in average-performing AMCs answer the important questions: “What are we doing wrong?” and “How can we move the big dots in the right direction?”
Keroak and colleagues collected measurements on four of the six attributes of quality health care: patient safety, mortality, clinical effectiveness, and healthcare equity. Because consensus around measurements for patient centeredness and outpatient care were not available at the time of the study, the authors did not include these measures in their analysis. Seventy-nine AMCs in the University HealthSystem Consortium (UHC), an organization of 97 university teaching hospitals across the United States, were included in the study.
Safety measures were determined by evaluating preventable complications known as patient safety indicators (PSIs) as determined by the Agency for Healthcare Research and Quality (AHRQ). Such measures are abstracted from hospital discharge information and include conditions such as nosocomial infections, falls, and wrong-site surgery. Mortality measures were determined by evaluating risk-adjusted mortality rates for selected inpatient diagnoses. For the area of clinical effectiveness, the authors used compliance with the Joint Commission (JC) Core Measures and 14-day surgical readmission rates for the same condition or surgical complication as their measure of quality. Finally, equity of care was evaluated by analyzing JC Core Measure diagnoses looking for disparities of care across gender, race, and socioeconomic status.