Testimony of Carolyn Clancy before the Senate Health, Education, Labor and Pensions Committee
May 5, 2011
Good morning, Senator Harkin and members of
the committee. I am very pleased to be here today to talk to you about our
Administration’s efforts to improve the quality and safety of health care.
The title of this hearing—"First, Do No Harm:
Improving Health Quality and Patient Safety"—is very fitting. It is one of the
earliest lessons that a medical student learns, and it is a promise that a medical
student makes when he or she receives a white coat on becoming a doctor. But not doing harm is just the bare minimum
for health care; we all strive for so much more.
Health care professionals go to work every
day wanting to provide the highest quality, safest, most appropriate care for
their patients. The bottom line is that patients should not go to a hospital or
other health care setting with a fear that they will get sicker not better. Unfortunately, with the complexity of health
care, deficiencies in the systems in which they practice, needed improvements
in teamwork and communication, and impaired information flow, high-quality,
safe health care may be perceived as a challenge.
We have made progress in engaging doctors,
nurses, patients, and others involved with our health care system in working together
to make the challenge less daunting and high-quality, safe health care a
reality; however, we have a lot more work to do.
Before I outline two exciting new initiatives
recently announced by the Department of Health and Human Services (HHS) to
address these challenges, I would like to describe briefly a snapshot of the
quality of our health care system to help frame our discussion today.
Scope of the Problem
The 2010 National Healthcare Quality
Report, released earlier this spring by my Agency, the Agency for
Healthcare Research and Quality (AHRQ), found that improvements in health care
quality continue to progress at a very slow rate—about 2.3 percent a year.
Data from other sources also highlight the problems:
results are simply unacceptable because we know we can do better. And we must
The National Strategy for Quality Improvement in
We need to accelerate our overall efforts to
improve quality and focus specific attention on areas that need the greatest
In March, HHS released a roadmap that will
guide us to making lasting, measurable improvements in the quality and safety
of health care services for all Americans.
The National Strategy for Quality Improvement
in Health Care, commonly referred to as the "National Quality Strategy," was
called for under the Affordable Care Act and is a significant step in creating
national aims and priorities to guide efforts to improve the quality of health
care in the United States.
The fundamental objective of the National
Quality Strategy is to promote quality health care that is focused on the needs
of patients, families, and communities. At the same time, the strategy is
designed to move the system to work better for doctors and other health care
providers—reducing their administrative burdens and helping them collaborate to
Before I provide you with a broad outline of
the National Quality Strategy, it is important to note that it was developed
based on evidence-based results of the latest research. Moreover, it was a
collaborative, transparent process that included input from a wide range of
stakeholders across the health care system, including Federal and State agencies,
local communities, provider organizations, doctors and other health care
professionals, patients, businesses, employers, and payers. In addition, I
would like to note that we are working closely with the developers of the
National Prevention Strategy.
This process of engagement will continue in
2011 and beyond. The National Quality Strategy is designed to be an evolving
guide for the Nation, as we continue to move forward with efforts to measure
and improve health and health care quality. HHS will continue to work with
health care providers and its other partners to create specific quantitative
goals and measures for each of these priorities. While the strategy articulates
common goals, it is not intended to specify how those goals are achieved. Rather,
the strategy explicitly recognizes the importance of encouraging and learning
from local innovations in improving care.
At its core, the National Quality Strategy
will pursue three broad aims. These aims will be used to guide and assess
local, State, and national efforts to improve the quality of health care. The
aims are as follows:
Better Care: Improve the overall
quality by making health care more patient-centered, reliable, accessible, and
Healthy People/Healthy Communities:
Improve the health of the U.S. population by supporting proven interventions to
address behavioral, social, and environmental determinants of health in
addition to delivering higher quality care.
- Affordable Care: Reduce the cost of quality
health care for individuals, families, employers, and government.
To advance these aims, we plan to focus
initially on six priorities. These priorities are based on the latest research,
input from a broad range of stakeholders, and examples from around the country.
They have great potential for rapidly improving health outcomes and increasing
the effectiveness of care for all populations.
six priorities are as follows:
care safer by reducing harm caused in the delivery of care.
that each person and family is engaged as a partner in their care.
effective communication and coordination of care.
the most effective prevention and treatment practices for the leading causes of
mortality, starting with cardiovascular disease.
with communities to promote wide use of best practices to enable healthy
quality care more affordable for individuals, families, employers, and
governments by developing and spreading new health care delivery models.
These priorities can only be achieved with
the active engagement of health care professionals, patients, health care
organizations, and many others in local communities across the country. Since
different communities have different assets and needs, they will likely take
different paths to achieving the six priorities. This Strategy will help to
assure that these local efforts remain consistent with shared national aims and
Over time, our goal is to ensure that all
patients receive the right care, at the right time, in the right setting, every
time. The United States leads the world in discovering new approaches to prevent,
diagnose, manage, and cure illness. Our institutions educate and train
exceptional doctors, nurses, and other health care professionals. Yet,
Americans don't consistently receive a high level of care. Achieving optimal
results every time requires an unyielding focus on eliminating patient harms
from health care, reducing waste, and applying creativity and innovation to how
care is delivered. The National Quality Strategy provides the framework to
Another important component of the National
Quality Strategy is that it aligns and coordinates the wide range of interests
and efforts to move quality forward. Everyone involved in health care has an
important role in promoting high-quality care. It starts with health care
providers, but employers, health plans, government, advocates, and many others
also have an interest in improving the quality of care. Employers and other
private purchasers, for example, have been leaders in demanding better quality
by pushing provider organizations to achieve new levels of excellence.
The National Quality Strategy outlines a
common path forward for all these groups and aims to make high-quality,
affordable care more available to patients everywhere.
The Strategy will be updated annually and
will provide an ongoing opportunity to identify and learn from those providers
and communities that are leading the way in delivering high-quality, affordable
care. It is our hope that this national strategy creates a new level of
collaboration among all those involved with health care delivery who are
seeking to improve health and health care for all Americans.
The Affordable Care Act calls on the National
Quality Strategy to include HHS agency-specific plans, goals, benchmarks, and
standardized quality metrics where available. By design, the Strategy does not
include these elements in the first year, in an effort to allow them to be
developed with additional collaboration and engagement of the participating agencies,
along with private sector consultation.
We believe nationwide support and subsequent
impact is optimized when those needed to implement strategic plans participate
fully in their development. We have begun implementation planning across HHS
and have established a mechanism to obtain additional private sector input on
specific goals, benchmarks, and quality metrics in 2011.
As implementation proceeds, we will monitor
our progress in achieving the Strategy's three aims, along with other short-
and long-term goals, and will refine the Strategy accordingly. Our goal is to
keep this Strategy open and inclusive. One way in which we hope to achieve this
goal is to provide updates annually.
The National Quality Strategy is available at
Additional background information can be found at http://www.ahrq.gov/workingforquality/.
It is hoped that other public and private
groups seeking to promote better health and health care delivery will also use the
National Quality Strategy to hold themselves accountable. AHRQ is tasked with
supporting and coordinating the implementation planning and further development
and updating of the Strategy.
The Partnership for Patients: Better Care, Lower Costs
As I noted during my introduction, we need to
make sure that patients feel safe going to the hospital and other health care
settings. Ensuring the safety of patients is integral
to the National Quality Strategy and a significant priority for this
Hospitals are showing that it is possible to
deliver better care. We can, over time, eliminate many types of patient injury.
The way to do that is to improve the care systems to allow doctors, nurses, and
others to do what they desperately want to do: deliver safe care. And what's clear is that no one can do this
alone. America's doctors and nurses are already doing their best to take care
of their patients. Simply telling them to solve this problem on their own would
be both unfair and unproductive.
To that end, the Department is bringing
together leaders of major hospitals, employers, health plans, physicians,
nurses, patient advocates, and others in a shared effort to make hospital care
safer, more reliable, and less costly for all Americans.
Last month, we launched The Partnership for
Patients—a landmark initiative with two basic but fundamental goals: (1) prevent
patients from being harmed while in the hospital and (2) reduce the number of
preventable rehospitalizations that occur after patients are discharged from
The specific objectives under these goals are
challenging, but we believe that they are achievable, and we have set a goal
that by the end of 2013, we can reduce cases of preventable harm by 40 percent
compared to 2010 and reduce rehospitalizations within 30 days of discharge by
20 percent compared to 2010 by targeting preventable readmissions.
rewards are worth the challenges we may face. Our
estimates are that the process of reducing preventable hospital-acquired
conditions by 40 percent will prevent 1.8 million injuries and avert 60,000
deaths of hospital inpatients over the next 3 years.
20-percent reduction in hospital readmissions would result in eliminating 1.6
million unnecessary rehospitalizations. Reaching both these targets would save
up to $35 billion across our health care system over 3 years, including up to
$10 billion for Medicare. Over 10 years, the reduction in Medicare costs could
be around $50 billion.
This initiative has been
developed over the last several months under the leadership of HHS and its agencies,
including my own, the Centers for Medicare & Medicaid Services (CMS), the
Centers for Disease Control and Prevention, the Office of the Assistant Secretary
for Health, the Food and Drug Administration, the Health Resources and Services
Administration, the Administration on Aging, and the Indian Health Service, as
well as with our colleagues at the Department of Veterans Affairs' Veteran's
Health Administration, and the Department of Defense's Military Health System.
CMS will commit up to $1 billion
in new funding from the Affordable Care Act toward achieving the goals of the
Partnership for Patients. Since the program was announced, the CMS Administrator,
Dr. Donald Berwick, has been leading the program through CMS's Center for
Medicare and Medicaid Innovation and has interacted with thousands of health
care providers, hospital leaders, and others at in-person meetings and on
national conference calls.
Under the initiative, we are
providing hospitals and physicians with an unprecedented range of resources
about what other health care providers have already done, and are doing, to
improve patient safety. Already more than 1,250 hospitals across the country
have pledged their support as well as clinicians and other care providers,
health plans, unions, employers, and consumers and patient organizations. In
the months to come, we expect that number will continue to grow.
The Partnership for Patients is pursuing a variety of activities to
make significant improvements possible nationwide. Three of these activities
are as follows:
- We are developing,
testing, and making available specific and useful tools that are based on the
best research to date on what works to prevent adverse events and
rehospitalizations. These include a tool to help prevent pressure ulcers in
hospitals (http://www.ahrq.gov/research/ltc/pressureulcertoolkit/) and another
tool to avert dangerous blood clots that can occur after surgery.
- We are continuing to
support efforts to spread successful innovations that have worked well in one
or a few hospitals to larger and more diverse settings. This will build off of
HHS's previous experience in these areas:
- One of the best
examples is a project in Michigan to reduce central line-associated bloodstream
infections in hospital intensive care units. This resulted in at least a 45-percent
reduction in these dangerous infections in less than 18 months. These
reductions have been sustained for more than 5 years. Currently, there is an
ongoing, nationwide effort to implement the quality improvement program that
yielded these results, and we are excited to report that 22 States are seeing
similar reductions in these life-threatening infections.
- Another very
successful initiative involves the prevention of unnecessary readmissions
through the Re-Engineered Discharge Project, known as Project RED. Patients who
have a clear understanding of their after-hospital care instructions, including
how to take their medicines and when to make followup appointments with their
doctors, are 30 percent less likely to be readmitted or visit the emergency
department than patients who lack this information.
- We are identifying
private sector initiatives that have led to useful tools or generated exemplary
results. Some examples of promising private sector initiatives are the recent
toolkit developed by the March of Dimes to help prevent harm to mothers or
infants during the birth process and work published by Ascension Health on how
that hospital system has greatly reduced obstetrical adverse events.
Public-private partnerships are
critical to the success of the Partnership for Patients. The Federal Government
is partnering with other public- and private-sector groups to encourage
patients and families to participate in their care to improve transitions
between hospitals and home and securing the active involvement of other
organizations representing patients, families, and consumers, in efforts to
prevent unnecessary rehospitalizations.
know that the new Center for Medicare and Medicaid Innovation, AHRQ, and the
other participating Federal agencies have a collaborative role to play with
stakeholders to achieve these ends and that a top-down solution is not the road
will come as health care providers and hospital leaders adopt or develop, and
then actually implement, methods that have been shown to be effective. As we
recommend and implement new methods to improve patient safety and care
transitions, the new Center for Medicare and Medicaid Innovation will test how
to introduce national models known locally to improve care and reduce costs. In
the coming years, it is our intent that a greater portion of Medicare's
hospital payments will be tied to quality results and to reward those that
deliver the best care.
know that the type of change we are talking about today will not come easily. But
we also know it can be done if we work together. By assembling this Partnership
for Patients and by committing to its ambitious goals, we are sending a clear
message that we can no longer accept hospital care in which safety and
efficiency is not the norm. We need a cultural change in our health care system
to make safe, high-quality care our top priority.
Mr. Chairman, thank you again for inviting me
to discuss National efforts to improve the quality and safety of our Nation's
health care system.
Through the National Quality Strategy and the
Partnership for Patients, we are committed to working closely with our
Departmental colleagues, States, and the private sector to ensure that all
patients get high-quality, safe, appropriate, and affordable health care.
I appreciate this opportunity and look
forward to answering any questions.
Current as of May 2011
First, Do No Harm: Improving Health Quality and Patient Safety. Testimony of Carolyn Clancy before the Senate Health, Education, Labor and Pensions Committee, May 5, 2011. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/test050511.htm