But then, in a program launched in 2004, more than 100 Michigan intensive care units managed to reduce these infections by two-thirds — and save some 1,500 lives in just 18 months — using a short checklist of practices for handling the catheters, and a culture change aimed at getting all staff on board. Hospitals around the country then took up the challenge, and the results were impressive.
The trouble is, there are plenty of other problems that may not be susceptible to an approach that tests a simple process that can then be used nationwide. A recent program looking at lapses that could lead to surgery on the wrong section of the patient found that errors can creep in just about anywhere, from scheduling to the marking of the surgical site. A couple of hospitals, for example, were using pens whose ink washed off during surgical prep, making the marks useless. Flaws in this process vary from one hospital or surgery center to another, says Mark Chassin, M.D., president of the Joint Commission, the major accrediting organization for hospitals.
Other, apparently straightforward problems — like health care workers not washing their hands — have proved surprisingly stubborn. Only about half of hospital workers follow hand-washing guidelines, despite excellent staff training and ubiquitous hand sanitizer dispensers at many hospitals, says Robert Wachter, M.D., a patient safety expert at the University of California, San Francisco. He points out an airline pilot would be disciplined or fired for ignoring safety rules. But while penalizing careless individuals remains controversial — and largely untried — in health care, activists have made hospitals more accountable.
Public reporting of hospital performance, more or less unheard of a decade ago, has been an important strategy. Twenty-nine states now require public reporting of hospital infection rates, and 28 require some information on medical errors. The HHS website has now added a key catheter infection rate, along with other results.
There are hundreds of ways to measure safety performance, from death rates after heart surgery to whether doctors gave the right antibiotic. What to report has been a major debate. Infection rates, initially resisted by hospitals, are now generally regarded as some of the most reliable data available to the public, since in most cases reports are made through a standard system developed by the U.S. Centers for Disease Control and Prevention.
Money may be another motivator for hospitals. In 2008 Medicare took the small step of restricting payments to hospitals for extra costs associated with 10 hospital-acquired conditions. This year it will begin giving extra money to hospitals that score the highest on a set of standards linked to better results for patients.