I just spent two days at the preconference part of IHI's 20^th annual quality forum and the first thing I did when I got home (aside from dealing with my son's now ex-wisdom teeth) was to get right back on the phone to the IHI conference. This post will have two parts based on that conference call with IHI CEO Don Berwick and colleagues. First, we'll tell you about what the Five Million Lives Campaign has achieved and where they go next, and then we'll fill you in on what an Obama administration means for health care quality (keep reading, in Berwick's view it's all very encouraging). In the coming days, I'll post a bit more about what I learned in Nashville.

The Institute for Healthcare Improvement is wrapping up its two-year "Five Million Lives Campaign" aimed at avoiding patient harm in hospital settings. Did it prevent Five Million injuries? IHI doesn't know for sure yet. Even when they finish analyzing the data they may not have a precise answer partly because we don't yet have good, nationally accepted uniform tools for measuring such things as "injuries that didn't happen."  But the partial data coming in from some states is very encouraging.  The data include drops, for instance, in pneumonia for patients on ventilators, reduction of other hospital-acquired infections, fewer dangerous decubitus ulcers (which the nonexperts reading this probably know as bedsores). Plus the buy-in by hospitals—and increasingly hospital boards, an explicit goal of the campaign—has been remarkable. Around 4,000 U.S. hospitals, representing 85 percent of all hospital beds in the U.S. and including 1,700 rural hospitals, took part. "The energy is phenomenal," Berwick said.

What next—apart from number crunching? More work, said Berwick. We have pockets of success, but millions of patients are still being harmed.

Three examples of upcoming initiatives:One is a package of quality measures aimed at helping hospital CFOs find ways to make quality improvement and cost reduction go hand-in-hand. Obviously they need all the tools they can get given the pressures the economic crisis is putting on hospitals. Second, is an initiative to reduce catheter associated urinary tract infections which IHI says are dangerous, expensive and often avoidable.

Third is a surgical checklist, developed for the World Health Organization in part by Dr. Atul Gawande, the surgeon and New Yorker writer. Gawande said the goal is to standardize risky processes in operating rooms, whether in the highest of high-tech U.S. hospitals or one in a poverty stricken part of Africa. The world has more than 230 million operations performed each year—here in the U.S. we do the equivalent of one operation for every seven people each year. That's lots of room for errors and complications, many of which don't have to happen.

Since the WHO checklist was launched in June, four countries have put it info effect (UK, Ireland, Jordan and the Philippines). With the exception of Washington State (has it thought about putting "Early Adopters" as a slogan on its license plates?) the checklist is getting off to a slower start in the U.S., but that's about to change. IHI is mobilizing its 4,000 campaign member hospitals. Expect to see a safety checklist posted in an OR near you...

Now onto the national agenda. The other day I posted about the worry, among some, that there could be a rift between reformers focused on coverage expansion and those focused on fixing the way we deliver health care. I wrote that, from my perspective here in D.C.,  the two camps seem to be overlapping more and more with a shared understanding that cost, coverage, and quality are three sides of the same coin (obviously not your standard two-dimensional coin). And then I said I'd let you know if my stint in Nashville surrounded by 6000 delivery system folks changed my mind. It didn't. And Don Berwick stated it very clearly today: "The central issue is universality and coverage."

"I am expecting good news," he said, of the incoming administration. "There are clear signals from all the principals who are involved," he said, listing Obama, Daschle, and key senators. "There's a strong interest in improving care." One of the ways to improve care is to link it to expanded coverage, he stressed. "I think we are going to see some pretty healthy steps taking us forward."

After all, all the quality initiatives in the world can't really make a quality system if 46 million people are left out....