Pronovost cautions that process measures, such as whether a heart attack patient received an aspirin, are what make up the Joint Commission's criteria, exclusively. They're not outcome measures of whether the care provided improved the patient's condition, required readmission, or resulted in death, "which is what the public really cares about."
An SEC for healthcare
What this country needs, Pronovost tells me, is "a Securities and Exchange Commission for healthcare."
"Look at what we have for financial reporting," he says. "There's public rule setting so accountants don't make up the rules, and there's private sector auditing and transparency. You can go on EDGAR and get a list of anyone's financial performance. But in healthcare, we haven't created those rules yet. Everyone's doing their own thing. And the public is left saying, 'what do I do? Here's a report saying a hospital is great and another saying it's not so great.'"
"We have to have some coordination, some standard rules, so there's a common truth to what we're talking about."
Pronovost makes clear that he wishes Johns Hopkins Hospital was on the Joint Commission's list, and says his teams are working very hard to get there. But one of the things he correctly notes is that the list is mainly made up of "a preponderance of very small hospitals that typically perform very well."
After the Commission's first list came out one year ago, Pronovost says, he and other Johns Hopkins quality leaders "called around and asked what would it take to do well on these. And what we found is that these hospitals do what's called 'a concurrent review.' Typically they have a nurse reviewing all of their charts, and if you don't give whatever it is to the patient, there is someone who is there to look after that."
Pronovost says that's an easy thing to do in a 100 or 200-bed hospital, "but if I have a 1,000 bed hospital, a big academic medical center, that's a much bigger investment."