Fixing healthcare from the inside: embracing improvement science

Dr James is a surgeon, statistician and director of quality at Intermountain Healthcare, a 23-hospital group in Utah, United States. Introducing his unflinching review of current healthcare, Dr James said that hospitals were a major public health problem – an opening line which takes some beating. He also objected strongly to the phrase ‘healthcare is broken’ because of its implication that healthcare systems were working in the first place.

His thesis is that even when we are not directly harming patients in hospital, the massive variation in clinical care provided to in-patients is wasteful, potentially harmful, and consumes resources that should be directed to more effective care. Worldwide, clinicians also exhibit a striking inability to do what we know works well.

He points out that we have met the enemy of high-quality, safe, patient care: it is us – all of us.

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