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• How the Newly Vigorous Patient Safety Regulatory Environment May Be Harming the Cause of Safety

  In responding to dysfunctional systems, America instinctively turns to “more regulation” (Exhibit A: today’s Wall Street). But regulation can, and often does, go too far, and – in patient safety – I believe that it now has.Note that this comes from someone Read More... Posted Sun, Oct 19 2008 8:34 PM by Bob Wachter | 6 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• NPR’s “Talk of the Nation,” Featuring Don Berwick and Yours Truly

  Medicare is now reporting actual risk-adjusted mortality rates for pneumonia, MI, and heart failure. The topic must be important, since "Talk of the Nation" spent 30 minutes yesterday interviewing Don Berwick and me about it… on the day of Hillary’s speech! Read More... Posted Wed, Aug 27 2008 7:08 PM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Information Technology, Health Policy, Media/Press Coverage

• Post-Vacation Potpourri: Items Interesting, International, and Ineffably Sad

  Just returning from a work-acation, including a talk in Buenos Aires. Today I’ll briefly cover a few items: Medicare’s final “no pay” list; patient safety in Argentina; a great post on hospital finances; and one of the saddest things I’ve ever experienced. Read More... Posted Thu, Aug 14 2008 3:07 AM by Bob Wachter | 0 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• The New (CMO) Math: Passion + Power = Progress

  In his five years on the job, Dr. Ernie Ring taught me why the Chief Medical Officer role is crucial, and how to do it right. Since Ernie is retiring at week’s end, it seems like an opportune time to share what I’ve learned.A bit of background. UCSF Medical Read More... Posted Wed, Jun 25 2008 8:36 AM by Bob Wachter | 3 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• The Best and Worst of Times For “Infection Preventionists”

  As I mentioned in my last post, these should be the best of times for "Infection Preventionists" (formerly known as Infection Control Officers). After years of trying to get someone – anyone – to pay attention to their work, their day in the sun has finally Read More... Posted Mon, Jun 23 2008 5:51 AM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Information Technology, Patient Safety/Medical Errors, Health Policy

• Could Intensivists Be Harmful to ICU Patients’ Health?

  Of all the structural (how care is organized) “evidence-based markers of high quality care,” perhaps the most ironclad has been the involvement of critical care physicians in the care of ICU patients. That is, until now. In a sophisticated study in today’s Read More... Posted Wed, Jun 04 2008 7:34 AM by Bob Wachter | 8 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Health Policy

• Average Time of Discharge: Why a Hospital is Not a Hilton

  Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.” But when did we turn into the Holiday Inn? Read More... Posted Wed, Mar 26 2008 7:05 AM by Bob Wachter | 14 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Efficiency, Hospitalists/Hospital Medicine

• The Great Quality Debate: Berwick’s Plea for Action vs. Evidence-Based Medicine

  In this week’s JAMA, Dr. Don Berwick, CEO of the Institute for Healthcare Improvement, argues that evidence-based standards should be relaxed for quality improvement practices. Ironically, a few pages away, a Swiss study finds than an IHI-endorsed MRSA Read More... Posted Mon, Mar 17 2008 11:59 PM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• And Speaking of the Unintended Consequences of Quality Measurement...

  I must have "you can't manage what you don't measure" on the brain – here's a piece I wrote this week for AHRQ's Guidelines/Quality Measures Clearinghouses called "Is the Measurement Mandate Diverting the Patient Safety Revolution?" Well, of course it Read More... Posted Tue, Mar 04 2008 4:06 PM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors

• Quality Measurement and the Risk of Yin Without Yang

  "You can’t manage what you don’t measure." This well-worn business axiom has been embraced by the healthcare quality movement, a trend this is healthy and long past due. But it comes with a risk: Yin without Yang. What do I mean? With the (still scanty) Read More... Posted Sat, Mar 01 2008 10:20 PM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors

• The Checklist Saga: Victory!

  I must admit, I didn’t hold out high hopes that a ragtag band of committed clinicians and other quality improvers could change federal policy. But we’ve done just that. If the Feds are capable of rectifying this mistake, who knows what might be next! Read More... Posted Sat, Feb 16 2008 7:24 PM by Bob Wachter | 5 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• Time to Write Congress re: The Checklist Debacle

  Thanks to all of you who have taken the time to write, blog, and rant about the OHRP's horrific decision to shut down the Hopkins-Michigan ICU checklist study, a decision that threatens the future of quality improvement and safety efforts in American Read More... Posted Fri, Feb 15 2008 5:52 AM by Bob Wachter | 1 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy

• Is Medicare’s “No Pay for Errors” Plan a Good Idea?

  In this month’s issue of the Joint Commission Journal of Quality and Patient Safety, I (with UCSF’s Adams Dudley and the American Hospital Association's Nancy Foster) tackle this provocative question. The answer may surprise you: yes (probably). The devil Read More... Posted Mon, Feb 11 2008 7:34 AM by Bob Wachter | 2 Comments Filed under: Quality Improvement, Hospital Care, Pay-for-performance, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Patient Safety/Medical Errors, Nurses/Nursing, Media/Press Coverage

• Did I Violate Federal Regulations Today? (I Hope So)

  The patient safety and quality movements are precious and fragile. Just as IOM reports I and II spawned these modern, life-saving revolutions, the Federal shutdown of the Hopkins/Michigan checklist program may help extinguish them. After all, Tipping Read More... Posted Wed, Jan 16 2008 7:39 AM by Bob Wachter | 8 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage

• Bureaucracy Run Amok: Can Checklists Kill?

  As you may know, I’ve argued that that the quality and safety of healthcare have traditionally been underregulated. But regulators are like patients with Parkinson’s: it’s hard to get them unglued, but once they’re moving, it’s hard to stop them. Welcome Read More... Posted Fri, Jan 11 2008 4:16 AM by Bob Wachter | 10 Comments Filed under: Quality Improvement, Hospital Care, Quality Measurement, Medical Education/Academia, Patient Safety/Medical Errors, Health Policy, Media/Press Coverage