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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

• 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 | 9 Comments Filed under: Hospital Care, Transparency and Reporting, Quality Measurement, Information Technology, Patient Safety/Medical Errors, Industry/Pharma

• Is it “Macaca” Time in Healthcare?

  August 11th was the 2nd anniversary of the epic implosion of George Allen's presidential campaign, the first defeat at the hands of YouTube. Two recent videos of unattended patients dying in ER waiting rooms leave me wondering whether healthcare has also Read More... Posted Tue, Aug 19 2008 8:00 AM by Bob Wachter | 1 Comments Filed under: Hospital Care, Transparency and Reporting, Information Technology, Patient Safety/Medical Errors, 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

• 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