Feedback loops are essential to every learning system. And the faster the feedback, the more accurate, actionable and impactful are the improvement of processes and outcomes.
Think about the speed with which Amazon, eBay, and other internet vendors understand your needs and tailor to them. Think of the continuous feedback sought by every company that interfaces with consumers, and how effectively many use that feedback. Also think of what happens when the feedback is ignored. In 1999, the Institute of Medicine (IOM) published the first in a series of reports on the Quality of Health Care in America. A key finding was the lack of systematic measurement and feedback on the quality of care delivered by clinicians.
As a result, the IOM proposed to prioritize areas of focus, including the most common chronic conditions. In early 2004, the IOM hosted the 1st Annual Crossing the Quality Chasm Summit and published a report of its proceedings. Much like the original report, the Summit recommended that measurement of the quality of care for a small number of highly prevalent chronic conditions was an essential step.
Many organizations participated in this Summit and made bold and definitive statements about the path forward. It’s important to note that there never was a second summit. And just about 10 years later, the state of reporting on these chronic conditions is abysmal. In fact, the state of reporting on quality of care delivered by clinicians in ambulatory settings is shamefully lacking.
A few months ago the Health Care Incentives Improvement Institute, along with Catalyst for Payment Reform, published a state by state report card on the availability of pricing information to residents of each state. That report showed that only two states in the U.S. received an A for price transparency with 29 graded F. Today we are following up that report with a companion that highlights the availability of information on the quality of care delivered by physicians. Had we focused tightly on the priority areas identified by the IOM, the scores would have been worse than they are. As it is, only two states get an A and 40 get a F. The results are, incredibly, worse than for the availability of pricing information.
We spend our days and evenings discussing the woeful state of health care in America. We lament that quality isn’t improving enough, that costs are too high, that patients are left to fend for themselves. And all those statements are true enough, but how in the world can and should we expect the quality of care to get better if we don’t measure it and report it? How can we expect clinicians to improve without feedback loops?
Our decade of experience working with clinicians on Bridges to Excellence shows very clearly and unequivocally that when clinicians are provided actionable and timely feedback loops their performance improves. We’ve also shown that better quality of care for patients with chronic conditions is also more affordable care.
So here are the real questions to ponder: Where are all those champions that signed up to forge ahead in early 2004? Why haven’t they devoted all their energy and might to change health care in America? Because the truth is that they haven’t. The promises they made, as it appears today, were empty.
In “To Err is Human,” the IOM asks us to look at ourselves in the mirror because we are the problem and only we can be the solution. Our second report card provides a mirror to all and what it shows isn’t pretty. We can and must do better. Some are, such as the Aligning Forces communities supported by the Robert Wood Johnson Foundation. But it’s not enough, not close. So many came on those cold January days a decade ago, and only a few stuck to their commitments. Today, we see the result of that lack of commitment and all should bow their heads in shame.