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• Are We Finally Entering the Golden Age of Healthcare Transparency?

  When will patients start reviewing quality data before choosing their doctors and hospitals? The answer has been “soon” for several years, but “soon” may finally be the right answer. If you doubt it, check out the Commonwealth Fund’s new site, “Why Not Read More... Posted Sat, Dec 27 2008 3:15 PM by Bob Wachter | 7 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Information Technology, Health Policy, Media/Press Coverage

• My Patients Are Dying… And I’ve Never Been Prouder

  I’m on clinical service now and my patients are dying left and right. And I’ve never been prouder of my own care, and that delivered by my colleagues and hospital.When I was in training, a patient’s death was invariably considered a medical failure, and Read More... Posted Thu, Nov 27 2008 8:16 PM by Bob Wachter | 6 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Medical Education/Academia, Hospitalists/Hospital Medicine, Health Policy, Medical Ethics

• 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

• Big Brother Arrives: Monitoring Patient Safety Compliance By Remote Video

  Today came the announcement that Suzanne Delbanco, founding director of the Leapfrog Group, has assumed the presidency of a company that tracks compliance with safety and quality practices via remote video. Big Brother, meet the Joint Commission.The report, Read More... Posted Tue, Sep 23 2008 8:18 AM by Bob Wachter | 10 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Information Technology, Patient Safety/Medical Errors, Industry/Pharma

• 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

• Door to Antibiotics Time in Pneumonia: Lessons from a Flawed Quality Measure

  In today’s Annals of Internal Medicine, my colleagues and I describe the saga of the four-hour measure of door-to-antibiotics time for pneumonia – the first truly dangerous measure in the era of public quality reporting. It is an important cautionary Read More... Posted Wed, Jul 02 2008 8:09 AM by Bob Wachter | 4 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• How Infection Prevention Came to Dominate the Patient Safety Movement

  The Joint Commission just released its 2009 National Patient Safety Goals, and – no surprise – they focus on infection prevention. While this seems natural today, it wasn’t always so. In fact, the conflation of infection control and patient safety is Read More... Posted Sun, Jun 22 2008 1:10 AM by Bob Wachter | 2 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Nurses/Nursing, Health Policy

• Message to Medicare: Whoa, Nellie!

  Last week, Medicare proposed nine additional “do not pay” conditions, several months before implementing the first eight. I like the concept of not paying for preventable adverse events, but this new list is a case of too far, too fast. In my previous Read More... Posted Mon, Apr 28 2008 7:37 AM by Bob Wachter | 7 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Patient Safety/Medical Errors, Health Policy

• Should Patient Satisfaction Scores Be Adjusted for Where Patients Shop?

  Last week, Medicare added patient satisfaction data to its hospital reporting website. This is progress, but it raises an interesting question: should patient satisfaction scores be case-mix adjusted? The motivation to include patient satisfaction data Read More... Posted Sun, Apr 13 2008 4:03 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Pay-for-performance, Transparency and Reporting, Quality Measurement, Hospitalists/Hospital Medicine, Information Technology, Health Policy, Media/Press Coverage

• 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

• Fixing Fumbled Handoffs

  I recently participated in a meeting whose aim was to develop safety measures for hospital units (ie, med-surg, ED, L&D). As various measures were being ticked off, I muttered that we should also try to capture errors that occur as patients move between Read More... Posted Tue, Dec 25 2007 2:24 PM by Bob Wachter | 4 Comments Filed under: Quality Improvement, Hospital Care, Transparency and Reporting, Quality Measurement, Ambulatory/Primary Care, Patient Safety/Medical Errors, Health Policy