Assessing Patient Safety Practices and Outcomes in the U.S. Health Care System

By Donna O. Farley; M. Susan Ridgely et al. | Go to book overview

Seattle, Washington

CONTEXT AND HISTORY

Market Composition and Competition

The major hospital systems in the Seattle area include Swedish Medical Center, Virginia Mason Medical Center, University of Washington Medical Center, Overlake Hospital, and Harborview Medical Center (the main trauma and safety-net provider, affiliated with University of Washington). Hospitals in the Seattle area have been expanding both in the core urban Seattle area and also in the surrounding suburbs. Physicians have been gravitating toward profitable services (e.g., ambulatory surgery centers, sleep centers, vein clinics, laser surgery), partly to cope with financial pressure resulting from increasing operating costs and relatively low reimbursement levels from health plans and public programs. Financial pressures are also encouraging physicians in smaller practices to join larger groups or seek hospital employment. Safety-net providers are struggling to meet demand as the number of uninsured rises.

Premara Blue Cross is one of the largest insurers in Washington state. Others include Aetna, Regence Blue Shield, and Group Health Cooperative (a staff/group model health maintenance organization [HMO] whose direct services focus on ambulatory care). Under pressure from employers to contain costs, health plans are paying closer attention to measuring provider-network performance. Accordingly, health plan products in Seattle are shifting toward tiered networks with preferential cost sharing for consumers who choose providers in the highquality/low-cost tier.


Past Activities and Experiences

Seattle has a diverse and competitive group of health care providers, although the competition tends to be less “head-to-head” and more segmented—either by service (e.g., medical specialties and “centers of excellence”) or by geography (e.g., urban versus suburban). Despite the competition, the Seattle health care community has a long history of collaboration and health care coalitions evidenced in past community public-health and quality-improvement initiatives (the latter particularly through IHI and regional learning collaboratives). This “culture of collaboration” has been partially attributed to a pervasive “voluntary” ethos (hospitals are nonprofit) and strong relationships among senior leaders across providers, payers, and government agencies (many of whom trained together locally).


CURRENT COMMUNITY COLLABORATIONS

Six currently operating Seattle-area collaborative programs were identified.


Washington Patient Safety Coalition

The main collaboration, the Washington Patient Safety Coalition (WPSC), was founded in 2002 after leaders from the State Department of Health and the Health Care Authority (public healthcare purchaser) attended an AHRQ-sponsored safety conference. The two organizations approached the Foundation for Healthcare Quality in Seattle as a trusted neutral home for the initiative to bring together multiple interests and stakeholders. The focus of the WPSC has been on supporting safety improvement among health care providers and sharing of best practices. The coalition was initially formed around hospital-based Patient Safety Officers, but also has enlisted a range of participants, including government agencies, insurers, and employers. It has

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