Profile: Carolyn Clancy on a mission to error-proof healthcare system

Profile: Carolyn Clancy on a mission to error-proof healthcare system

For Carolyn Clancy, key ideas for improving the healthcare system often come from everyday life.

About 25 years ago, while working in a free clinic, Clancy heard a pharmacist tell a patient about his medications, then ask him to repeat what he’d heard. That simple interaction — confirming that the patient had absorbed the information — struck Clancy as revolutionary.

“I almost fell over,” Clancy said. “I didn’t have a name for that, but I knew it was profoundly important. I’d never been taught that.”

Now, as director of the Agency for Healthcare Research and Quality (AHRQ), Clancy looks to those types of individual experiences as she searches for new ways to make healthcare safer and more effective. AHRQ controls hundreds of millions of dollars in federal grant money, primarily to test and help expand new tools for keeping patients safe.

The obstacles to better, safer healthcare are familiar: Orders get lost or confused; one doctor doesn’t talk to another; a nurse gives the wrong dose of a medication. 

And then there’s the added challenge of hospital-acquired infections.

“It’s kind of astonishing how many opportunities there are to drop the ball,” Clancy said in an interview with The Hill.

But she said understanding the basic model for solving those problems is as simple as recognizing that coffee shops get your order right because the employees repeat it back to each other.

“It’d be nice to get to a place where healthcare is at least as error-proof as Starbucks,” Clancy said.

Getting there, however, is more difficult.

Clancy was first tapped as AHRQ director in 2003, then reappointed in 2009. She and the agency have been working for decades on ways to improve patient safety, but she said the broader healthcare system has only recently caught up.

“We’ve been working on this for a long time, and the really fantastic news is, I think the country is ready for this,” Clancy said.

She is eager to describe some of the most successful research projects AHRQ has funded, including an initiative to reduce hospital-acquired infections in Michigan. Researchers from Johns Hopkins University spearheaded the project after testing a handful of safety measures.

The research was narrowly targeted to a specific series of infections, but those diseases were especially dangerous. The mortality rate was as high as 25 percent.

“They didn’t say, ‘We thought they were inevitable,’ but, ‘We were trying really hard and we just seemed to be stuck with a high rate of infections,’ ” Clancy said.

Researchers used a basic checklist, combined with a different approach from hospital leadership and new procedures that let hospital employees act as checks on one another. The results were “dramatic,” Clancy said.

AHRQ is now working with other stakeholders to expand the principles of that experiment to cover more conditions and geographic areas.

The agency mostly funds research and publishes findings, so it doesn’t have the same muscle as Medicare, whose purchasing power is the government’s primary lever for changing the healthcare delivery system. But the two agencies work together, and Medicare’s efforts are informed by AHRQ’s research.

“We’re giving them fuel,” Clancy said.

Medicare administrator Don Berwick praised Clancy’s work.

“Carolyn has been a fantastic partner in our efforts to improve the quality of healthcare,” he said in a statement. “When it comes to promoting patient safety and reforming the way we deliver healthcare, she understands how critical our work is to the future of our nation.”

Doctors, nurses and other healthcare professionals want to make care safer, Clancy said, but they need concrete systems to make it happen.

“There’s an openness about the fact that we can, must and really want to do better that is unprecedented — so much so that I don’t think that awareness and aspirations are actually the problem,” Clancy said. “I think the problem is how. How do you make it easy?”

Better coordination of healthcare services is a key goal of the healthcare reform law. It established several programs and new initiatives to provide doctors with new incentives to work together, and tests new payment models that supporters hope will usher in a new era of collaborative medicine.

(Those initiatives are not without their skeptics, though, including several large hospitals that are considered models of integrated care.)

Clancy said the healthcare world has been moving gradually toward a new, safer model for a long time, but said the healthcare law, known as the Affordable Care Act, also helps.

“I think what’s different now is the context in the wake of the Affordable Care Act,” Clancy said. “I think providing and receiving safe, high-quality care is not remotely a partisan issue, but the context has changed quite dramatically. And it’s very exciting.”

The Affordable Care Act created a new, nonprofit institute for comparative effectiveness research — comparing various treatments to see which works best. It’s a controversial area of medicine; some Republicans see comparative effectiveness as a gateway to rationing. They fear that the government will one day only cover the treatments that are most cost-effective for a majority of people.

The healthcare law stipulates that Clancy, along with the head of the National Institutes of Health, will sit on the board for the new panel. But she said the controversy over comparative effectiveness hasn’t been an obstacle for AHRQ so far.

“We’re at a place where it’s a natural evolution of the scientific investments we’ve made, and frankly our world leadership in this area, that we’ve got an array of options,” she said. “And the real question is, what’s the science that helps you apply that precisely? That’s really our focus.”

Ultimately, Clancy said, tools like Medicare and comparative effectiveness are only part of the process for making care better and safer.

“When I think about the impact of policy on improving care, there’s the specific policies, but it’s also the culture,” she said. “And I think the good news — and this is part of why I feel like the healthcare system is ready — is that the culture has been slowly evolving to recognize that you don’t get high-quality, safe care just because you want it.”