JAMA: Berwick, McCannon comment on Partnership for Patients

On April 12, the U.S. Department of Health and Human Services launched the Partnership for Patients initiative, signaling a “shared investment in ending preventable harm to patients and improving transitions in care, building optimism that the era of incremental change has passed,” wrote C. Joseph McCannon, AB, of the Centers for Medicare & Medicaid Services (CMS) and CMS Administrator Donald Berwick, MD, MPP, in a June 1 commentary in the Journal of the American Medical Association.

Business leaders in hospitals and other healthcare organizations need stronger external incentives to change from the status quo, while clinicians need to hone the work of introducing improvement in care, according to the authors. “Leveraging the Patient Protection & Affordable Care Act legislation and resting on unprecedented collaboration between the public and private sector, the initiative seeks to alter the mindset and strategies of everyone involved in healthcare and to build a national network of learning and exchange that will substantially increase the rate at which healthcare professionals identify and eliminate all forms of patient injury.”

Berwick and Cannon noted the following aims of the Partnership for Patients:

• Accelerate the reduction of harm to patients in hospitals: By the end of 2013, the nation should achieve a 40 percent reduction in preventable harm compared with 2010, amounting to approximately 1.8 million fewer injuries to patients, 60,000 lives saved and $20 billion in healthcare costs avoided.
• Decrease preventable hospital readmissions within 30 days of discharge: By the end of 2013, readmissions would be reduced by 20 percent compared with 2010, meaning prevention of more than 1.6 million hospital readmissions and an estimated $15 billion in healthcare costs avoided.

Noting that the goals are “bold” and the time frame is “aggressive,” the authors opined that improvement and support to healthcare professionals can be reinforced with forward-thinking, applied strategies including:

• Alignment of the public and private sectors. The initiative will depend on collaboration among all stakeholders in care; the government cannot simply promulgate policy and expect results. Payors, purchasers, clinicians, policymakers and patients need to align their efforts and activities, putting aside historical differences in pursuit of improvements in care.
• Improved accountability and oversight. For an enterprise as important and consequential as healthcare, government oversight and regulation are inevitable. However, excessive requirements and lack of alignment often breed mistrust and create an administrative burden for hospitals. This initiative will seek to improve survey and certification processes, targeting preferred quality behaviors, and linking underperforming facilities to learning resources that will help them rapidly improve performance.
• Engagement of patient, family and caregivers. The initiative will invest significantly in raising patient and family awareness of threats to safety and will invite patient groups to join in designing and delivering better care, the authors stated.
• Use of measurements that encourage learning and progress. Ongoing reporting benchmarks and forthcoming payment incentives notwithstanding, the Partnership for Patients will seek to create, for two to three years, a safe space where clinicians will be judged not on their performance in comparison to one another but their performance against the highest standards of excellence. Failures will be opportunities for learning and the initiative will reward outstanding successes and celebrate collective progress.

“With the leadership, timely investment and unprecedented alignment and collaboration that the Partnership for Patients calls for, continually improving patient safety in the United States is achievable,” the authors concluded. “Success now depends on the authentic commitment and collaboration of all stakeholders in healthcare.”