"Quality is Job One" by Elmer Freeman

“Quality is job one” became the advertising mantra of the Ford Motor Company in the 1980’s following the surge in foreign car sales that began to exceed that of manufacturers in the United States as American consumers began to demand fuel efficient and better quality automobiles. The focus on quality came too late for a full recovery, and two decades later the patient’s health continues to decline and the prognosis is not good.

On September 16, 2008, Charles Kenney, former journalist at The Boston Globe, introduced his new book, The Best Practice: How the New Quality Movement is Transforming Medicine, to the health care establishment of Boston, touting such ideas and concepts as the introduction of the principles of quality in the Toyota Production System being employed at the Allegheny General Hospital. The forum was sponsored by Blue Cross Blue Shield of Massachusetts and hosted by its Chairman and CEO, Cleve Killingsworth, writer of the foreword to the book, who issued a “call to action” for transformation of the system to improve quality, and promote affordable patient centered health care.

A quick scan of the room and of the table full of name badges, I determined that the forum drew 350+ people from the major teaching hospitals, medical schools, networks and health plans all interested in identifying ways of improving quality and increasing productivity while also keeping health care affordable.

The Best Practice Quality Forum featured a keynote presentation by Donald Berwick, President and CEO of the Institute for Healthcare Improvement who campaigns for saving 100,000 lives and protecting 5 million from harm through quality improvement initiatives. Sorrel King who lost her daughter due to medical error and champions efforts to give greater involvement and control to parents and other responsible relatives in the care of their family members, gave a passionate presentation. Charles Kenney’s presentation preceded the panel discussion among three of the leaders in the healthcare quality movement written about in his book, with each one providing valuable lessons from their experiences in the healthcare quality imperative. Kenney’s book documents the challenges faced by these three, as well as other leaders in the quality improvement arena in health care. It provides the inspiration necessary for taking on the complicated compounded complexities of quality improvement.

Studies have demonstrated and the evidence is clear of the relationship between quality measures and potential for cost savings. Dr. Berwick made the case for cost savings to be realized by decreasing hospital infections and medical errors and investing in quality improvement strategies and techniques. Single payer advocates have long made the case for cost savings on the administrative operations of the system. There seems to be equal or greater savings to be realized on the clinical operations as well. Health reform as we know it in Massachusetts is very much tied to what we can achieve in quality improvement and cost containment.

Under Chapter 58, the Health Care Quality and Cost Council is charged with “establishing health care quality improvement and cost containment goals to promote high-quality, safe, timely, efficient, equitable and patient centered health care” in Massachusetts and the Council released a progress report on patient safety efforts two days after the Forum. Kenney’s book of stories of these visionary leaders should be required reading for the members of the Council and everyone in Massachusetts concerned about the sustainability of universal coverage for all of the citizens of the Commonwealth.

Elmer Freeman is Executive Director of the Center for Community Health Education Research and Service, Inc. and Co-Chair of the Disparities Action Network.

This program aired on October 13, 2008. The audio for this program is not available.

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Martha Bebinger Reporter
Martha Bebinger covers health care and other general assignments for WBUR.



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