Now, Bisognano says, the trick is to figure out how reducing costs can improve quality.
In his keynote talk, Don Berwick, MD, former administrator of the Centers for Medicare & Medicaid Services and IHI's cofounder, did not mince words about where he thinks much of the quality improvement and cost reduction should come from.
Alluding to the "monsters" that his grandson believes hide under his bed, Berwick identified 11 "monsters" that now block the road to higher quality and lower costs. And many of these monsters are policies or practices that encourage waste and maintain elaborate infrastructures to perpetuate unjustifiably excessive profits for some companies and providers, he said.
For example, he referred to credible estimates that more than 50% of the stenting and coronary bypass procedures performed today don't resolve symptoms, and don't extend life or prevent heart attacks.
Just imagine, he implored the crowd, if this were correct.
"All those angiography suites, all those operating rooms, all those proud and technically brilliant interventional cardiologists, what happens to them? What happens to the business models of heart hospitals, the stent vendors, when the evidence accumulates that what we do a lot of doesn't help nearly as much as we thought it did. It is scary to ask," he said.