TEDMED’s 20 Great Challenges – Eliminating Medical Errors Also Requires Educating the Young

I have really enjoyed following the progress and discussions related to the TEDMED 20 Great Challenges program to be held in conjunction with TEDMED, next April 16-19 in Washington DC. TEDMED is working to increase awareness and develop a deeper understanding of these Great Challenges to Health and Medicine, defined as persistent problems that have medical and non-medical causes, impact millions of lives, and affect the well-being of all Americans. During this past year’s 2012 TEDMED gathering in Washington, DC — also streamed simultaneously to hundreds of auditoriums nationwide allowing as many as 50,000 offsite Delegates to participate via a remote simulcast called TEDMEDLive — the TEDMED community defined, discussed, and voted for, these 20 Great Challenges of Health and Medicine. For the coming year, the Great Challenges Program will generate a lively national dialogue around each of the Challenges chosen by the TEDMED community.

I was excited to see that “Eliminating Medical Errors” was one of the 20 Great Challenges, as this is a problem that persists despite the hard work of many of us who have dedicated our careers trying to prevent. As I navigated through this category on the TEDMED site, I noticed a “fill-in-the-blank” question posed by the event organizers in the discussion section:

–To eliminate medical errors we must…

As so often happens when I get that type of prompt, I instinctively blurt out the same thing I said many years ago – a quote that has literally followed me around the world, and was the inspiration for this blog. If you want to eliminate medical error “Educate the young and regulate the old,” I repeated. The story behind my statement is the basis of my premiere ETY blog post of the same phrase, and can be found here.

As someone who has spent his entire career in safety and quality, it has not been an easy road. For years, the incentives were horribly misaligned. Even when caring and compassionate caregivers spoke up for change, sharing evidence-based work that demonstrated new ways to reduce risk to patients, financial leadership would push back citing decreased reimbursement and lack of funds to support quality and safety efforts. It was frustrating to argue with the “bean counters” who saw bottom-line dollars and financial capital more important than human capital. So in the heat of my frustrations that day while participating on the closing panel of an Australian patient safety conference, I instinctively replied “Educate the young and regulate the old”.

But think about it…this is exactly what is happening in healthcare today. Rules and regulations driving value-based purchasing, decreased reimbursements for hospital readmissions, and incentive-based core measures are just a few examples of the new medical-financial lexicon. The Triple Aims of care – highest quality, sustained wellness, at the greatest value where patients are true partners in their care, is now the preferred framework for delivery of care. All collectively represent the medical language of the 21st century…long overdue in the eyes of many at the frontlines of patient care, but now understood by those in the financial suites trying to balance budgets using healthcare’s “new world accounting”.

In addition to these new regulations, educating the next generation of caregivers to meet these needs and speak the new language is critical in order to achieve the success we are striving for, as well as address the new requirements of healthcare. Health science curricula can no longer remain in the dark ages, and will need to design educational models and coursework that address the changing needs of healthcare, such as:

  • Patient-centered care over physician-centered care
  • Quality of care provided instead of volume of procedures done
  • Outcome measurements and transparency instead of denial and ego-driven beliefs of quality
  • Open and honest communication instead of “deny and defend” tactics when unintentional patient harm occurs

By training students and residents on these newer, safer and higher quality models of care, evolution to highest-quality, lowest-risk care at good value will become a reality. The next generation of caregivers needs to hit the ground running if we are to accelerate achievement of these goals. I hope educators and student leaders are included in the TEDMED 20 Great Challenge discussions next spring–not only to educate the next generation on these issues, but also because they will provide a fresh outlook to problems that continue to challenge all of us in the delivery of safe care.

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