machines, which nurses use to automatically dispense medications. Improper stocking of medications (known as stock outages) leads to wasted time and resources to find medications that should be there. A hospital O’Neill observed had 57 Pyxis machines and incurred 983 stock outages in a single month. In a disaggregated form, these numbers might not mean anything. However, when compared to a perfect health care system without stock outages, the inadequate supply of medications should be viewed as a systems failure, leading to extra work and wasted resources. In another example, an equivalent of 11 full-time nurses was used to look for equipment in a single year, instead of using their knowledge and skills to treat patients, O’Neill said. Many other examples exist that yield similar value propositions that can help improve the value of health and medical care without challenging medical knowledge.


Denise Dougherty of the Agency for Healthcare Research and Quality (AHRQ) provided the complementary patient perspective of problems with quality during clinical care. To characterize the urgency of the problems, Dougherty provided national snapshots of issues in quality based on data from AHRQ’s National Healthcare Quality and Disparities Reports, which identified many variations in care. Quality and quality improvement rates varied by delivery setting (e.g., hospitals saw more improvement than ambulatory care centers, nursing homes, and home health care) and by state without a good explanation for why these variations occur. For example, the worst performing state admits five times as many children for asthma into its hospitals than the best performing state. Although we know that a proportion of these hospitalizations could be prevented with appropriate and timely ambulatory care, benchmarks are unknown and need to be developed. Through the lens of the IOM’s six aims for quality—safety, effectiveness, timeliness, patient centered, efficient, and equitable—one can easily identify many more deficiencies in care. Based on the data, progress has been made in many areas of health care quality (overall improvement rate was 3.1 percent between 2005 and 20061), but improvement has been slow. Acceleration of improvements and reductions in disparities in quality are necessary to better serve patients and increase the value of health care to patients and payers.


This was determined by averaging improvement rates of core measures of the National Healthcare Quality Report.

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