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Statement By CEO At Health Care Reform Town Hall Forum

Tuesday, September 01, 2009

The current debate on health care reform has strayed from the most important goal: improved health for all Americans, according to James M. Anderson, president and CEO of Cincinnati Children’s Hospital Medical Center, who today addressed a raucous crowd gathered at the University of Cincinnati.

The entire text of Jim Anderson’s remarks (as prepared in advance), follow below.

Good morning. I want to thank Sen. Brown for giving me the opportunity to be part of today’s discussion.

Let me start by saying, I’m not here to advocate for a particular piece of legislation, but I do think it is truly a debate and certainly a subject matter that warrants much discussion. I want to complement Sen. Brown for facilitating that.

While much of the focus of the health care debate has been around insurance and costs, I want to encourage and even challenge us to think of reform in a different light: quality improvement of the delivery system to improve health for Americans. The key in all that we do through reform be hard-wired to a single objective: improving health for Americans. I think we may have strayed from that singular goal.

Cincinnati Children’s has unusual and useful experience to bring to a discussion of quality improvement. We’ve learned we can provide care that achieves better outcomes and better experiences for patients and families and — this is the news that we all want to hear — and provides significant savings in health care costs.

Based on our experience, I’m absolutely convinced that whatever direction health care reform takes — and, in fact, whether or not Congress passes any reform legislation — hospitals and physicians must become more focused on the quality, safety and reliability of our health care delivery systems.

I’m not alone in thinking this. There are a handful of others speaking out for this point of view across the country.

For instance, in a recent op-ed in the New York Times, Paul O’Neill asked:

1. Which of the reform proposals will eliminate the millions of infections acquired at hospitals every year?
2. Which will eliminate the annual toll of 300 million medication errors?
3. Which will eliminate pneumonia caused by ventilators?
4. Which will eliminate falls that injure hospital patients?
5. Which will capture even a fraction of the roughly $1 trillion of annual “waste” that is associated with the kinds of process failures that these questions imply?

His answer is: None of them. And he’s right.

The discussion has become almost exclusively focused on insurance plans, universal coverage, public and private options.

We need to talk about those things, but if that’s all we talk about, we’re not going to get the improved outcomes we all want. The health care debate should have as its single guiding principle improved health for Americans.

Policymakers should be asking: how can we support and encourage hospitals and physicians to invest resources of time, money and effort in quality improvement?

Having said that, I would also invite my colleagues in health care not to wait. Let’s take care of the things we can control: the quality and safety of the care we provide.

That’s health care reform from within, and when we embrace that type of reform, the results are exciting: Better medical and quality of life outcomes. Better patient and family experiences. And better value.

It’s a win-win. Investing in improving quality and safety is the right thing to do for patients, and happily, it’s also the smart thing to do for the business of health care.

You might be asking: How can he be so sure?

My answer is that Cincinnati Children’s has been working at this for more than 10 years, and we have seen the evidence. We’re a good working laboratory demonstrating how hospitals and physicians can achieve improved outcomes, patient and family experiences and value — all resulting in healthier citizens at lower cost.

What is quality care? There is a clear answer — and it’s not just mine. It’s an answer given by the Institute of Medicine more than a decade ago.

In the late 1990s, the IOM concluded that the US health care delivery system needs fundamental change to deliver care that is:

1. Safe
2. Timely
3. Effective
4. Efficient
5. Equitable, and
6. Patient-centered

That’s what Cincinnati Children’s means when we speak about quality improvement. We have worked on process changes to be better in all of them. We’re not alone in this effort to improve. A quality movement has started. A handful of hospitals are leading the way, and though there’s a lot more to be done, the work is already producing impressive results.

We are very much a part of that movement.

Our goal is to build reliable, high-performing, family-centered systems, and we’ve achieved things many people — including us — doubted were possible when we began.

The work is not easy. It takes commitment and a willingness to change: We’ve looked outside health care to learn from other high-risk industries. We’ve learned there is a science of improvement, and we’ve trained leaders and frontline staff to use it. We’ve involved families in helping us design systems that meet their needs and improve the experience of care. We’ve used information systems to support the drive for quality improvement. We’ve measured outcomes for everything we do.

It works.

These are a few of the things we achieved:

1. Created evidence-based guidelines – basically a roadmap for physicians and nurses -- that reduced unnecessary hospitalizations for five common conditions — by 23% (asthma, bronchiolitis, community-acquired pneumonia, fever of uncertain source, and gastroenteritis)
2. Reduced surgical site infections — by 64%
3. Reduced ventilator-associated pneumonia — by 93%
4. Reduced catheter-associated blood stream infections — by 71%
5. Reduced serious safety events — by 70%
6. Reduced adverse drug events — by 80%

The first rule of medicine is “Do no harm.” So we’re delighted that we’re saving children from dangerous, sometimes fatal complications of care that are clearly preventable.

But we’re finding that the work has important financial implications as well. One of the oddities of the US health care delivery system is that there’s been a lot of skepticism that there’s really a business case for investing in quality improvement. Other industries know that high quality and cost effectiveness go hand in hand. But not health care.

When Cincinnati Children’s began its quality journey, we were convinced that improving outcomes and customer experiences would reduce operating costs as well. But at that point it was more faith than fact. Now we have evidence.

For example, we analyzed the cost savings from just two projects — surgical site infections and ventilator-associated pneumonia — over a two-year period. By reducing preventable infections, we saved nearly $5 million.

One more financial note: We also saved $6 million in two years in malpractice insurance, settlement payments and defense costs. While not all of this can be attributed to quality improvements, it is at the very least a happy coincidence.

These are savings achieved at one hospital and group of physicians. Imagine if they were multiplied 5,000 times over if all US hospitals joined the quality movement.

Our message to colleagues in hospitals across the country is simple: Our experience at Cincinnati Children’s — and results at other hospitals that have embraced the quality agenda — shows we can achieve:

1. Safer care
2. Efficient processes that make the best use of the patient’s and caregiver’s time and the institution’s resources
3. Better patient experiences and outcomes, and
4. Better value.

Those are results we all want — whether we’re patients, caregivers or health care executives. And it all results in improved health for Americans.

Thank you.