How can the application of the quality and safety principles outlined above result in cost savings in the delivery of health care? The business case for quality and safety is built on the concept of the elimination of waste in medical care. Brent James, executive director for the Institute for Healthcare Delivery Research at Intermountain Healthcare in Salt Lake City, identifies two main types of waste in health care (65). The first is quality waste, which can be thought of as rework or scrap. This is the failure to achieve the desired outcome of medical care the first time around. This would include such diverse events as medication errors that result in patient harm, hospital-acquired infections, wrong site surgeries, and retained foreign objects at surgery. The second type is inefficiency waste. This refers to excessive resource consumption to achieve an outcome when a different alternative is available to more efficiently achieve a similar outcome. An example would be performing an inpatient hysterectomy for menorrhagia that could be treated equally well with outpatient medication or endometrial ablation. James estimated that together these two sources account for as much as 50% of the expenditures on health care in this country (65). Combating these sources of wasted health-care dollars will require a widespread adoption of the principles discussed: the use of evidence-based medical treatments and safety technology; the elimination of unexplained clinical variation in our processes of care; improved teamwork and communication between providers in different disciplines; the direct involvement of patients and their families in monitoring their own care; and all of these under the guidance of committed health care leadership able to rally support for these efforts.
More evidence is emerging to validate these concepts. The Dartmouth Institute found a strong correlation between higher health care quality and cost savings in multispecialty groups (66). In 2010, the Rand Corporation produced a technical report showing that improved patient safety, as measured by a reduction in adverse events at hospitals in California, resulted in a significant reduction in malpractice claims (67). This represents a large potential cost savings and is an attractive alternative solution to the problem of substantial malpractice costs in our current health care system. The twin aims of improving the safety and quality of the medical care are goals that all physicians should actively pursue.
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