Good Medicine. UT System Points the Way in Clinical Safety and Effectiveness in Medicine.

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The University of Texas System stands at the forefront of a growing health care reform movement that promises to make medical practices and procedures more safe, efficient, and cost-effective for all Texans. This movement has been gaining momentum at various institutions around the nation for the last decade, but UT remains the leading institution in the academic world to tackle these issues on a system-wide basis. The recent Clinical Safety and Effectiveness Inaugural Conference and Recognition Event, which gathered experts from around the world in Austin, and honored pioneering projects from around the UT System, represents another important step toward providing Texans with the most effective, efficient and affordable medical treatment possible.

"What it's about more than anything is changing the culture of health care," declares Dr. Kenneth I. Shine, executive vice chancellor for health affairs, "from a culture in which the doctor knows all and is considered perfect, to a culture where we know we can always do better."

Shine, who's been involved with medical quality and safety challenges since 1968, says the reform movement’s been growing since 1999, when the Institute of Medicine (of which he was president from 1992 to 2002) issued a report called "To Err Is Human: Building a Safer Health System" which noted that fatal errors in medical treatment were far more common than believed. UT System, with the UT M. D. Anderson Cancer Center leading the way, has subsequently instituted several practices to counteract medical errors. UT M. D. Anderson Cancer Center instituted a course which not only instructed participants on improving clinical safety and effectiveness of medical care, but also required the participants to complete a project to accomplish these goals. This course and project requirement is now expanding to all of the UT health campuses.

As an outgrowth of such initiatives more than 420 faculty and staff have completed a course on patient safety and effectiveness. Some 55 groups presented abstracts on the subject at October's Clinical Safety and Effectiveness Conference in Austin. A team from The University of Texas Health Science Center at Houston was awarded $3,000 for the winning project: Improving Blood Product Delivery to the Operating Room for Pediatric Cardiothoracic Surgery. The team reduced the time required to get blood deliveries to the operating room down from 55 to 13.5 minutes. Runner-up presentations involved cutting the time to set up appointments for priority dermatology patients at UT M. D. Anderson from more than a week to less than 48 hours; reducing the rate of contaminated blood cultures at The University of Texas Health Science Center at San Antonio from 4.38 percent to 2.08 percent; and completely eliminating infections (previously seven a month) of elderly patients on respirators at UTHSC-Houston. In addition to improving the quality of care, each project saved money for its institution.

Since 2004, a "truth-telling policy" has been in place which encourages UT health representatives to promptly speak frankly and openly with family members when a patient suffers due to errors during treatment; the concerned family is told what went wrong and why, and receives an apology as well as an explanation of what UT will do to avoid repeating such mistakes. System "disclosure coaches" travel among the six medical campuses to train local personnel, from doctors and nurses to administrators, in how to conduct these sensitive communications.

UT System institutions are working with a patient safety organization, which under federal law allows information about failures to be reported and shared without recrimination. "We thus find out how errors took place and how to prevent them in the future," Shine says. "We want a situation in which errors at all our institutions don’t have to be repeated before they’re corrected."

Outstanding leaders of the patient safety effort can be elected as Fellows in Clinical Safety and Effectiveness. The Fellows organize projects and programs in medical research and patient safety. They also mentor other faculty, while the new responsibilities of the fellowship offer new career recognition, worthy of notation on their individual curriculum vitae. The UT System Board of Regents allotted more than $3 million for research and education related to patient safety and effectiveness. Two Chancellor’s Health Fellows, Dr. Eric Thomas and Sherry Martin, are leading these efforts across the UT System.

"Gathering data is critically important," Dr. Shine believes. "If you want to see change, collect data. Until you can use data to show there’s a problem, individual physicians and others may have no idea that's the case, or may not believe it; then you can use more data to show how the problem is corrected."

— John Morthland

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Institutionalizing Change:
UT Health Campuses Unite to Make Difference

If important change begins at home, UT System health institutions are in good shape. Dr. Kenneth I. Shine, executive vice chancellor for health affairs, remembers a time—barely a decade ago—when clinical safety and effectiveness was strictly a nurse's responsibility. "It was just not seen as the highest priority of an institution and its doctors," he recalls, "but now you have highly respected physicians leading the charge. That makes an enormous difference." So does the fact that the presidents of the health institutions are also involved, and that individual campuses are recruiting faculty with a specific interest in health services research; and establishing centers for quality improvement and/or excellence. "These people are institutionalizing changes, so we're seeing attitudinal changes about clinical safety and effectiveness across the board," Shine emphasizes. "That's what's important to me. I've been active in this area since 1968, and it can't be about one person. It has to be institutionalized. No other academic system has the kind of programs and initiatives we do; we are the leaders in this area and we need to continue to build on that."