Numerous studies have shown wide variability across both quality and safety in health care. Recent work by Sir Brian Jarman documents substantial variation among hospital death rates, as measured by the hospital standardized mortality ratio (HSMR). Even when multiple risk factors are considered, there is no clear explanation for differences in HSMR from hospital to hospital. The implication is that differences in care, rather than case mix or other patient or hospital variables, account for the differences in adjusted mortality rates.
An opportunity exists to close the gap among hospital death rates by improving hospital care. Early work on reducing mortality and review of the literature suggest three main systemic issues: failure to plan, failure to communicate, and failure to rescue. A set of high-leverage changes and a related measurement strategy have been proposed to deal with these systemic issues.
The HSMR, appropriately adjusted for multiple variables such as population characteristics and diagnoses, provides an essential starting point in improving care and reducing mortality.
Many hospital deaths could be prevented if all the factors that contribute to them were better understood. Each hospital death provides an opportunity for learning — by understanding and addressing local conditions that contribute to mortality.
