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Having the BHAG to shoot for the Moon

Did you know that up to 440,000 lives are lost annually in our hospitals due to preventable mistakes?

Because of this, we desperately need a Big, Harry, Audacious Goal (or BHAG) to solve this national tragedy, and it cannot happen soon enough. By the way, BHAG was a phrase coined by author Jim Collins.

On May 25, 1961, President John F. Kennedy addressed a joint session of Congress stating that the U.S. should set a goal of “landing a man on the moon and returning him safely to the earth” by the end of the decade. By making this bold statement, Kennedy captured the attention, imagination and collective will of our country. Eight years later, his BHAG was accomplished. Amazingly, we put a man on the moon using 1960’s technology.

In December 1999, the Institute of Medicine (IOM) released a seminal book, ‘To Err is Human: Building a Safer Health System.’ This book raised eyebrows and presumably generated supposed action. Using the annual estimate of 98,000 preventable hospital deaths, the IOM report attempted to galvanize this frightening number of avoidable deaths and set forth a worthy goal: “Given current knowledge about the magnitude of the problem, the (IOM) committee believes it would be irresponsible to expect anything less than a 50 percent reduction in errors over five years.”

Was the IOM goal reached in five years? No. In 15 years? Definitely not. Based on recent reports, preventable hospital deaths in the U.S. are greater than previously understood.

In 2013, the Journal of Patient Safety estimated that up to 440,000 lives may be lost annually in our hospitals due to preventable errors – over four times the number reported by the IOM. This equates to three jumbo jets falling from our sky EACH DAY, incurring 1,200 casualties. Another 10- to 20-times this number are seriously injured in our hospitals due to preventable errors. At best, we are making glacial progress.

Since the IOM report was released, the estimated number of lives lost due to hospital errors is alarming – between 1,470,000 and 6,600,000. Why such a chasm in numbers? Most errors go unreported for various egregious reasons. Our cobbled ‘system’ may kill as many people every eight days than were lost on 9/11 and in the Iraq and Afghanistan wars (9,469). Since 1999, more Americans have needlessly died in our hospitals than had died or were wounded throughout our entire history of wars (2.7 million).

‘To Err Is Human’ suggests that the problem is not bad people working in healthcare, but good people working in bad ‘systems.’ It is ironic that the very system we trust to ‘do no harm’ causes a great deal of lethal harm. Unlike actual jets falling from the sky, lives lost in our hospitals happen silently, one at a time. These fatal errors cannot be managed and improved if they are not first acknowledged and measured. Trust must be earned in healthcare, not blindly given. Without broad and consistent public outrage, this national tragedy will continue to persist with little hope of sustained improvement.

In our 2014 Iowa Employer Benefits Study, a top priority of Iowa employers is patients’ safety of care. Employers correctly perceive the safety issue has been inadequately addressed.

Because healthcare is local, solutions must be local. Hospital board members must insist that patient safety is paramount in setting their hospital’s long-term vision and mission. Their safety culture should permeate throughout the entire organization through policies, decision making, resource allocation, and most importantly, complete public transparency. Embracing this culture with words alone is nothing more than deceptive marketing fluff that silently kills.

If efforts to reach the moon were similar to how we confront safety of care, we would still be floating in boundless black space with little hope of reaching our destination. The BHAG we need in healthcare safety should be nothing short of landing on the moon by having the courageous willpower to get there – just like we did in the ’60s.

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What Iowa Employers Really Want: Cost, Quality and Safety

A bullhorn or Megaphone with the word Value to stress a companyIn our 2013 Study, Iowa employers rated healthcare providers within their respective communities on 11 performance indicators as well as ‘Trust.’ The results of this survey was summarized in our ‘Voices for Value’ white paper and serve as both a baseline and a conduit for additional, meaningful dialogue on how to improve the healthcare we receive in Iowa and elsewhere.

As a corollary to last year’s study, we asked employers this year to rate the importance of the 12 performance indicators using a 10-point scale, where 1 means “not at all important” and 10 means “most important.” The purpose of this module was to learn which of the indicators are most important to Iowa employers. Their answers to this significant question now provide a meaningful weight to how employers sounded off in our 2013  ‘Voices.’

From our latest study, Iowa employers have spoken yet again. When it comes to healthcare, they prioritized the three following indicators:

  1. Keeping Costs Reasonable
  2. Keeping Quality of Care Consistent
  3. Safety of Care Delivered to Patients

It’s a very reasonable request, don’t you think? After all, they are the ones paying for it.

Iowa Employers Rank Performance IndicatorsAll 12 indicators scored at least 7.9, which clearly suggest that ALL indicators are very important to employers. However, only three indicators scored at least ‘9’ – Cost, Quality and Safety. This appears to be very intuitive. But I must confess, I was somewhat surprised to learn that ‘Safety’ was an eyelash away from being the second most important indicator overall – and it was the top indicator for those employers with at least 250 employees.

Iowa employers are very perceptive; as ‘safety of care delivered to patients’ SHOULD be a priority for obvious reasons. For those who have followed my previous blogs, quality and safety issues in the U.S. healthcare ‘system’ are, at best, worrisome – and, at worst, reprehensible.

Perhaps we have suspected these results to be factual all along, but now we have undeniable evidence of what employers REALLY want from their community healthcare providers. When combining cost with consistent quality and safety of care, employers seek high-value healthcare from those who deliver it.

Employers have my attention – but they need the attention of those delivering the care for which they are handsomely paying.

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Iowa Employers – Interested in Valuable Safety/Wellness Resources at No Cost?

Since the physical health and safety of employees is paramount to having a successful and productive workforce, many Iowa employers have contacted me over the years seeking resources to help implement or improve their safety and/or wellness initiatives.

In the past, I have had the pleasure of working with the University of Iowa’s Healthier Workforce Center for Excellence (HWCE) on various research projects. HWCE’s recent focus in the wellness prevention and safety arena has been both impressive and forward thinking. Their desire to be a purveyor of resources to small- and middle- market employers in Iowa is admirable and well-intentioned.

Many employers, specifically smaller organizations, find themselves somewhat paralyzed on how to begin pursuing a wellness and/or safety program for their workplace. Unfortunately, they may become overwhelmed early in the process and disengage before they pursue a plan that can serve as the foundation for later alterations, experimentations and enhancements.

I am now pleased to share with you an opportunity to evaluate excellent, free resources through HWCE!

HWCE is currently seeking employers with 10 to 249 employees to provide feedback on these materials. Your input will be used to improve current resources offered by HWCE and to develop new materials. If you participate in the evaluations, you will receive these free materials as well as be given several opportunities to win $50. The first drawing will be held on November 10.

If you are interested or would like to learn more, please register at or contact Jenny Hall, HWCE’s associate director for outreach at 319-335-4200.

If you know of employers who qualify in size and may have an interest in learning more about HWCE and this particular program, I encourage you to share the link provided above.

Here’s to our collective health and safety!

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