Imagine a health care system where medical harms no longer occur. Where technology is connected and systems talk to each other. Where doctors, nurses, patients, and families work as a team, and decisions about health care are shared. Imagine a health care system that is so finely tuned that it can eliminate preventable harms, cut health care costs, and give patients and families the voice and care they deserve.
For the Gordon and Betty Moore Foundation, we imagine this, and we believe it can be a reality.
Helping us make this a reality are four academic medical centers known as the Libretto Consortium. The consortium includes Beth Israel Deaconess Medical Center in Boston, Brigham and Women’s in Boston, Johns Hopkins Medicine in Baltimore, and the University of California, San Francisco. Their efforts to address the problem of preventable harms are beginning first in the intensive care unit (ICU), one of the most complex and costly settings in health care. It is also where patients and their families are most at risk of experiencing preventable harms.
Unfortunately, every week people die from preventable medical harms, such as delirium, ventilator-acquired infections, and central-line associated blood infections. But there are other harms that should be prevented, too: specifically, the loss of dignity and respect among patients and their families, as well as care that is not consistent with their wishes and values. We view these harms as real and as preventable as medical harms. None are acceptable, and none of them should happen.
Our decision to fund the four centers is based in large part on their ability to make an impact in this critical area. Each institution has an outstanding reputation in patient safety and a strong commitment to patient and family engagement, along with a robust track record of quality improvement. Their individual efforts to eliminate preventable harms are some of the best examples in the United States, if not the world.
Our most recent grant, which was for $5.3 million over thirty months, was awarded to Beth Israel Deaconess Medical Center. Beth Israel has a rich history in patient and family engagement. It was the nation’s first hospital to create a Patient Bill of Rights in 1972. It is also known for delivering and demanding high-quality care. In 2008, Beth Israel announced its commitment to eliminate harms throughout its medical center.
For Libretto, the Beth Israel team will build off of its expertise in these areas, as well as its deep expertise in innovative technology, to develop care innovations to eliminate harms in the ICU. For example, one component of the center’s work is to develop a model for measuring and managing the leading indicators of risk for harm in the ICU. They are working with Massachusetts Institute of Technology systems scientists on this specifically, and the model will include a dashboard system to raise clinicians’ awareness of conditions that may threaten patient safety.
As important as the ability to make an impact is, there are other factors that played into our partner selection. As in our example with Beth Israel, we want to ensure that our partners share in the goal of our Patient Care Program: to eliminate preventable harms and unnecessary health care costs by meaningfully engaging patients and families in a redesigned, supportive health care system.
We also value a willingness to take risks. Eliminating preventable harms is challenging. Imagining the world we described above is easy, but creating it is not. With Libretto, we have partners who share in our program goal and in our foundation’s belief to take on challenges for transformational change. All four of the institutions are pioneers in their field, and each strives to deliver the best care possible. They seek out and take on new challenges, solve issues, apply lessons they’ve learned, and continue to push forward until they have succeeded.
The biggest challenge ahead for the Libretto Consortium is re-engineering the complex care delivery system so that it operates in an integrated manner. We believe that Libretto is the right group for this challenge and look forward to sharing outcomes along their journey. What they learn and then refine along the way will make the endeavor succeed and provide the kind of impact that our founders, Gordon and Betty Moore, desire: bold ideas that create enduring impact.
Editor’s Note: Related reading:
Table of Contents, February 2013 Health Affairs thematic issue on “New Era of Patient Engagement.” The issue was funded by the Robert Wood Johnson Foundation, the Gordon and Betty Moore Foundation, the Patient-Centered Outcomes Research Institute, and the California HealthCare Foundation.
“Patient Engagement, Patient Safety, and Quality of Care,” by Lee-Lee Prina, GrantWatch column, Health Affairs, February 2013 (free access).