Limits...
Market-based control mechanisms for patient safety.

Coiera E, Braithwaite J - Qual Saf Health Care (2009)

Bottom Line: To "cap and trade," a regulator would need to establish system-wide and organisation-specific targets, based on the cost of adverse events, create a safety market for trading safety credits and then police the market.Organisations are given a clear policy signal to reduce adverse event rates, are told by how much, but are free to find mechanisms best suited to their local needs.The market would inevitably generate novel ways of creating safety credits, and accountability becomes hard to evade when adverse events are explicitly measured and accounted for in an organisation's bottom line.

View Article: PubMed Central - PubMed

Affiliation: Centre for Health Informatics, Institute of Health Innovation, University of New South Wales, Australia. e.coiera@unsw.edu.au

ABSTRACT
A new model is proposed for enhancing patient safety using market-based control (MBC), inspired by successful approaches to environmental governance. Emissions trading, enshrined in the Kyoto protocol, set a carbon price and created a carbon market--is it possible to set a patient safety price and let the marketplace find ways of reducing clinically adverse events? To "cap and trade," a regulator would need to establish system-wide and organisation-specific targets, based on the cost of adverse events, create a safety market for trading safety credits and then police the market. Organisations are given a clear policy signal to reduce adverse event rates, are told by how much, but are free to find mechanisms best suited to their local needs. The market would inevitably generate novel ways of creating safety credits, and accountability becomes hard to evade when adverse events are explicitly measured and accounted for in an organisation's bottom line.

Show MeSH
Calculating safety credits. Two separate clinical organisations institute different harm-reduction projects, aimed at reducing locally relevant causes of regulated preventable adverse event (PAE) classes. Project impacts in reducing the incidence of PAEs are audited, and then a weighting index converts PAE reductions into a common costable metric, such as days in length of stay prevented. The aggregate cost of all projects for an organisation, expressed as the total number of harm reduction units (HRUs) achieved, is then compared with the organisation’s target HRUs. Surplus HRUs generate tradable credits, to be bought by organisations that miss targets.
© Copyright Policy - openaccess
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2657889&req=5

qhe-18-02-0099-f02: Calculating safety credits. Two separate clinical organisations institute different harm-reduction projects, aimed at reducing locally relevant causes of regulated preventable adverse event (PAE) classes. Project impacts in reducing the incidence of PAEs are audited, and then a weighting index converts PAE reductions into a common costable metric, such as days in length of stay prevented. The aggregate cost of all projects for an organisation, expressed as the total number of harm reduction units (HRUs) achieved, is then compared with the organisation’s target HRUs. Surplus HRUs generate tradable credits, to be bought by organisations that miss targets.

Mentions: Can we develop a similar tradable patient harm reduction unit (HRU) (fig 2)? Could we identify a “basket” of leading PAE classes to cover a good proportion of clinical practices, and associate each class with a common measure of resource consumption, which can be assigned a cost? Recent work suggests that such an approach is indeed possible. We now know that a wide variety of PAE causes can be collapsed into a smaller basket of “natural” outcome categories, each category associated with a cost (additional days length of stay).16 Runciman et al’s analysis of 15 000 hospital admissions also found that 25% of PAE resources were expended on the 11 most frequent PAE categories (table 1), 50% by the top 45. Any such basket of PAEs is bound to be revised as we better understand how it relates to safety outcomes.


Market-based control mechanisms for patient safety.

Coiera E, Braithwaite J - Qual Saf Health Care (2009)

Calculating safety credits. Two separate clinical organisations institute different harm-reduction projects, aimed at reducing locally relevant causes of regulated preventable adverse event (PAE) classes. Project impacts in reducing the incidence of PAEs are audited, and then a weighting index converts PAE reductions into a common costable metric, such as days in length of stay prevented. The aggregate cost of all projects for an organisation, expressed as the total number of harm reduction units (HRUs) achieved, is then compared with the organisation’s target HRUs. Surplus HRUs generate tradable credits, to be bought by organisations that miss targets.
© Copyright Policy - openaccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2657889&req=5

qhe-18-02-0099-f02: Calculating safety credits. Two separate clinical organisations institute different harm-reduction projects, aimed at reducing locally relevant causes of regulated preventable adverse event (PAE) classes. Project impacts in reducing the incidence of PAEs are audited, and then a weighting index converts PAE reductions into a common costable metric, such as days in length of stay prevented. The aggregate cost of all projects for an organisation, expressed as the total number of harm reduction units (HRUs) achieved, is then compared with the organisation’s target HRUs. Surplus HRUs generate tradable credits, to be bought by organisations that miss targets.
Mentions: Can we develop a similar tradable patient harm reduction unit (HRU) (fig 2)? Could we identify a “basket” of leading PAE classes to cover a good proportion of clinical practices, and associate each class with a common measure of resource consumption, which can be assigned a cost? Recent work suggests that such an approach is indeed possible. We now know that a wide variety of PAE causes can be collapsed into a smaller basket of “natural” outcome categories, each category associated with a cost (additional days length of stay).16 Runciman et al’s analysis of 15 000 hospital admissions also found that 25% of PAE resources were expended on the 11 most frequent PAE categories (table 1), 50% by the top 45. Any such basket of PAEs is bound to be revised as we better understand how it relates to safety outcomes.

Bottom Line: To "cap and trade," a regulator would need to establish system-wide and organisation-specific targets, based on the cost of adverse events, create a safety market for trading safety credits and then police the market.Organisations are given a clear policy signal to reduce adverse event rates, are told by how much, but are free to find mechanisms best suited to their local needs.The market would inevitably generate novel ways of creating safety credits, and accountability becomes hard to evade when adverse events are explicitly measured and accounted for in an organisation's bottom line.

View Article: PubMed Central - PubMed

Affiliation: Centre for Health Informatics, Institute of Health Innovation, University of New South Wales, Australia. e.coiera@unsw.edu.au

ABSTRACT
A new model is proposed for enhancing patient safety using market-based control (MBC), inspired by successful approaches to environmental governance. Emissions trading, enshrined in the Kyoto protocol, set a carbon price and created a carbon market--is it possible to set a patient safety price and let the marketplace find ways of reducing clinically adverse events? To "cap and trade," a regulator would need to establish system-wide and organisation-specific targets, based on the cost of adverse events, create a safety market for trading safety credits and then police the market. Organisations are given a clear policy signal to reduce adverse event rates, are told by how much, but are free to find mechanisms best suited to their local needs. The market would inevitably generate novel ways of creating safety credits, and accountability becomes hard to evade when adverse events are explicitly measured and accounted for in an organisation's bottom line.

Show MeSH