Massive Problem, Massive Solution

Last year, about 43 million people around the globe were injured from the hospital care that was intended to help them; as a result, many died and millions suffered long-term disability.  These seem like dramatic numbers – could they possibly be true?

If anything, they are almost surely an underestimate.  These findings come from a paper we published last year funded and done in collaboration with the World Health Organization.  We focused on a select group of “adverse events” and used conservative assumptions to model not only how often they occur, but also with what consequence to patients around the world.

Our WHO-funded study doesn’t stand alone; others have estimated that harm from unsafe medical care is far greater than previously thought.  A paper published last year in the Journal of Patient Safety estimated that medical errors might be the third leading cause of deaths among Americans, after heart disease and cancer.  While I find that number hard to believe, what is undoubtedly true is this:  adverse events – injuries that happen due to medical care – are a major cause of morbidity and mortality, and these problems are global.  In every country where people have looked (U.S., Canada, Australia, England, nations of the Middle East, Latin America, etc.), the story is the same. Patient safety is a big problem – a major source of suffering, disability, and death for the world’s population.

The problem of inadequate health care, the global nature of this challenging problem, and the common set of causes that underlie it, motivated us to put together PH555X.  Launching on September 16^th, it’s a HarvardX online MOOC (Massive Open Online Course) with a simple focus: health care quality and safety with a global perspective.  I believe that this will be a great course—not because I’m teaching it, but because we have assembled a team of terrific experts.  But, let me be clear:  putting this MOOC together is unlike any educational experience I have ever had before.

First, you get to assemble the faculty – and here, I had almost no constraints.  Want to learn about quality measurement?  We have Jishnu Das (World Bank economist whose ground-breaking work includes sending trained, fake patients into doctors’ offices in Delhi) and Niek Klazinga (a Dutch physician who led the creation of the Health Care Quality Indicators for the OECD).  These two guys have thought more deeply and broadly about quality measurement than almost anyone else in the world.  What about the role of leadership?  We have Agnes Binagwaho (Minister of Health, Rwanda) and Julio Frenk (former Minister of Health, Mexico and current dean of the Harvard School of Public Health) speaking about what leadership in quality looks like from a health minister’s perspective.  We have T.S. Ravikumar, the CEO of a massive public hospital system in Pondicherry, India talking about how his decision to prioritize quality transformed his institution. To close out the course, Ed Kelley, Director, WHO Service Delivery and Safety, offered his insight on setting a global agenda and the importance of cross-country learning. 

Sometimes, when you want the best people in the world, you don’t even have to go very far. On patient safety, we only had to cross the street for David Bates, Chief Quality Officer at Brigham and Women’s Hospital and patient safety maven. When we wanted to learn about the empirical basis for the role of management in improving quality, we went across town to Harvard Business School to spend time with Rafaella Sadun. And when we wanted to learn about quality improvement, we only had to cross the Charles River to find Maureen Bisignano, CEO of IHI.

Beyond getting to assemble an excellent, world-class faculty, the MOOC is a completely different approach to education.  Because this course has never been offered before –we had the freedom to write a fresh syllabus specifically for online learners. This is not a live course copied onto a web platform. These are not hour-long lectures videotaped from the back of a classroom.  Our lectures are short, pithy conversations on pressing topics.  Instead of asking Professor Ronen Rozenblum, an Israeli expert on patient experience, to lecture about how and why we might measure patient-reported outcomes, we are having a meaningful discussion – back and forth, where I get to challenge his assumptions and let him articulate why patient experience should be considered an integral part of quality and more importantly, why he cares.

Beyond the discussions, we have interactive sessions where students create content.  One of my favorites? Through this course we will crowd source the first global “atlas” on healthcare quality.  Lets be honest, it’s one thing for me to point to individual studies on hospital infections in Canada or India, but right now, we have no place to turn to if we want to really understand key issues in healthcare quality around the globe and how they compare to one another.  The goal of this exercise is as simple as it is ambitious. By the end of the course, we will draft a resource that maps out where the world is on the journey towards a safe, effective, patient-centered healthcare systems.  It will be created by the collective energy and creativity of people in the course – a range of students, providers, policy folks and people just simply passionate about improving the delivery of healthcare. It will be a public good for us all to use and improve.

Finally, we have a few enticements to keep everyone engaged.  The attrition rate in these courses tends to be high, so we have a few carrots.  First, half-way through the course we will have a series of live discussion in which expert faculty will help students solve pressing quality and safety problems in their own institutions.  Have a problem with high infection rates in your ICU?  We will get an expert on nosocomial infections to help you think it through and figure out how to begin to solve it.  Wondering how to keep your family members safe during their hospital visit?  We will have healthcare consumer experts help you navigate those waters.  Finally, at the end of the course, students have the opportunity to submit a 1200 word thought piece on the importance of improving quality and safety in their own context whether as a clinician, patient, or health policy expert.  The top three pieces will be published in the BMJ Quality and Safety, arguably the most influential global quality and safety journal.

This is a grand experiment in a new way of teaching, engaging, and creating information on quality and safety of healthcare.  I’m sure there are parts that won’t work, but we will learn along the way.  I’m also sure that the pressing issues facing the US – healthcare that is not nearly as safe, effective, or patient-centered as it should be – are similar to issues facing not just other high-income countries, but also low and middle-income countries. Thinking globally about these issues, and their adaptable solutions, can help us all deliver better care.

Quality needs to be on the global health agenda.  Don’t believe me?  Take the course.

Ashish Jha is a professor of Health Policy at the Harvard School of Public Health and a practicing Internal Medicine physician at the VA Boston Healthcare System. His HarvardX MOOC, PH555x: "Improving Global Health: Focusing on Quality and Safety," launches on edX on September 16.