Quality Institute.
Name: Laura L. Adams
Position: President and CEO, Rhode Island Quality Institute
Background: Adams has worked as a consultant in the improvement of
health-care quality and services. She is a faculty member of the Institute for
Healthcare Improvement in Boston. She has worked to bring principles of health-care
quality improvement to the Middle East in conjunction with the Harvard Institute
for Social and Economic Policy in the Middle East.
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Education: Bachelor’s degree, University of Northern Colorado (1978);
Master’s degree, University of Colorado (1986).
Age: 46
Residence: Swampscott, Mass.
The Quality Institute, founded in 2002, is dedicated to improving health-care
quality in Rhode Island by applying operational and technological approaches
to the system of care statewide. In 1999, Sheldon Whitehouse, then-Attorney
General of Rhode Island, catalyzed the group’s formation. The institute’s board
includes hospital administrators, doctors, nurses, pharmacists, business leaders,
insurers, state government officials and academic institutions committed to
working in concert to achieve an even higher level of quality care in the state.
PBN: The Quality Institute was founded less than a year ago. Explain the
group’s purpose to a businessperson or employer who might not be familiar with
it.
ADAMS: Health care as a sector of our economy in Rhode Island is huge,
not only in the number of jobs it represents, but in that it touches virtually
every other business aspect of this state. The Quality Institute was pulled
together with the expressed purpose of taking a look at a system that we know
has much room for improvement. You’d be hard-pressed to find anyone who’s completely
happy with the health-care system right now. So the institute wants to make
significant improvements in quality, efficiency and safety, and to look at aligning
incentives to promote that kind of transformation in health care. We believe,
to paraphrase Einstein, the significant problems we have in health care right
now cannot be solved with the same level of thinking with which they were created.
During the Quality Institute’s formation, it was billed as a way to give
businesses and other employers a voice at the table when it comes to health
care. How exactly does that happen?
That place at the table is alongside all the other major stakeholders. The Quality Institute wants to take on projects that no one entity can take on alone. We’ve seen various stakeholder groups try to make a significant change on their own, but by and large they are met with resistance from other components of the system. By getting everybody in the room to talk about the problems and potential solutions, to understand each other’s perspectives, business has opportunity to help guide the projects that we select and to talk about their needs in a forum that they maybe don’t have otherwise. It’s the ability to get with the providers and the insurers to discuss those issues in an open format where everybody’s willing to collaborate to make a change.
Any specifics?
Some businesses that have been involved with the Quality Institute have brought to us specific projects. For example the pharmacies and pharmaceutical companies came to us with the initiative for SureScripts, the electronic prescribing program (announced in February). That’s a major issue for their cost efficiency and safety and good patient care. That came out of one of the major businesses, CVS Corp. And the board meetings are open to anyone who wants to make a difference in health care.
Can you summarize the electronic-prescribing initiative?
It’s an effort to improve the electronic infrastructure of prescribers and to link them directly to their pharmacists. The relationship between the prescriber and the pharmacist has never been more important, to have that accurate, open and easily accessible. Beta testing of that project is going to occur in about three weeks, where we link our first set of physicians to the SureScripts system, to be linked to a number of pharmacies in the area. It’s an open platform so everyone can participate.
Any other initiatives?
Yes, one is the electronic intensive care unit. We understand from research at Johns Hopkins and other academic institutions that care is improved in the ICU when there is a specially trained physician available to help oversee that care. ‘Intensivists,’ as they’re known, are in very short supply. A company called VISICU has designed a system that will put an intensivist virtually, through electronic communications, at the bedside, 24/7. Studies have shown that that can reduce mortality rates by 30 percent, complication rates by 40 percent and the cost of hospitalization of ICU patients by 25 percent. Those are no small dollars when you think about the fact that, of every dollar that goes into the hospital, 30 percent is taken up by intensive care. The system would be relatively expensive, in fact unaffordable for any of our hospitals alone. But in collaboration, our hospitals can afford it.
So the Quality Institute attracts solutions from the private market for
use in Rhode Island?
Exactly. Companies have begun to approach us because what they see here is unique in the United States in that they can sit down at a table and have access to virtually every stakeholder they need to implement an important initiative. We see that as an innovation magnet for Rhode Island.
I’m sure you’re familiar with Leapfrog Group, formed in 2000 by a group
of executives at large corporations to improve health-care quality and efficiency
– essentially big business’s response to runaway health-care costs. Is the Quality
Institute modeled after Leapfrog Group?
I think it informed our thinking in some ways. As an industry, health care has been suggesting that people don’t buy on the basis of quality, so these businesses have stepped forward and said that they’ll begin to do that. They began to suggest that they would drive their business to those organizations that can demonstrate tangible improvements in quality. Some of our major initiatives overlap, but I wouldn’t say that we modeled their approach. That effort did not necessarily include the provider community. Some providers feel it was imposed on them.
Leapfrog Group uses its business as the carrot to reward providers to work
toward better quality. By including providers as part of the Quality Institute,
does that carrot go away? Can you expect to put providers’ feet to the fire
on quality and efficiency when they’re part of the group?
We believe that can happen, because we all have the same goals of higher quality and more efficient care, and we all want a structure that rewards the behaviors that produce that. We don’t know how it can be done without providers at the table, because so much change has to happen there. And it happens far more quickly if it’s done willingly and inclusively, rather than as an imposition. The enemy is disease and error and waste, not each other.
Rhode Island has been cited as a national model in pushing providers to
improve quality and monitor and report results, such as the “report cards” on
clinical care issued by the Department of Health in December. Hospitals and
nursing homes are getting more serious about their own quality initiatives.
How can a group like this expect to fit seamlessly with all these other efforts?
We’ve got a number of talented groups working on researching and studying the system and giving us that vital information. We’ve got others working on measuring and reporting on the performance of the system. What we saw as the gap was the group that would come together to actually make the changes. For example, each one of our entities can improve their own information system. But until there’s a body that can link all these information systems together, then a patient goes from one place to another, and their health-care information does not follow. There’s tremendous inefficiencies in that and there’s no other way to tackle that linkage of the system until somebody gets on the job of implementing the actual changes.
I’d imagine there are at least some costs that go into some of these ideas.
What happens when five hospitals say ‘this sounds great’ and five say ‘we can’t
afford to do this, we have our own initiative?’
We are interested in working with the willing, the people interested in moving ahead. And we’re interested in demonstrating our outcomes, looking at whether or not what we’re doing actually works. If it doesn’t and it isn’t better than what they’ve been doing already, then they shouldn’t adopt. If it is, then we hope that over time there will be more and more interest in adopting something when we can demonstrate superior outcomes.
Are there any other projects further down the road?
We were approached by RAND Corporation, a well-respected research firm out of California, which has developed an $18-million, 10-year study on a comprehensive set of indicators that have been researched and tested. These indicators measure both overuse and under-use. If Rhode Island were to be the pilot site, then we would build the infrastructure to have those measures automatically collected. Right now almost every quality measure we do is a tedious, expensive effort because much of it is manual. This project would involve the development of a great deal of information systems and infrastructure. So what we see is, RAND has a strong track record in being able to attract funding for their major projects. This would not only measure the quality of care but also prompt good care. It also would begin to measure the economic impact of the delivery of that care. For example, there’s a strong push toward prevention, and we support that. What are we going to get from those prevention efforts being put in place right now? Being a site that an organization like RAND can come to and have everyone they need around the table to institute a project like that, we can accomplish things here that we couldn’t afford otherwise.
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