We're always on the lookout for health care success stories. (Even if they are smaller scale than we'd like -- but we'll get to that.) Premier, Inc., a quality improvement alliance and group purchasing organization, just reported excellent quality results from a year-long initiative. It's called QUEST, which stands for Quality, Efficiency, Safety, and Transparency.

After sharing data, adopting measures such as aspirin and beta blockers for heart attack patients (inspired by CMS's Hospital Compare), rapid response teams (inspired by IHI, a QUEST collaborator  -- and written about by our program in our Baylor case study), and giving clear instructions to patients at discharge so they  are less of a readmission risk (a cost containment target for numerous reformers), the 157 participating hospitals calculated that they saved 8,043 lives and $577 million.  That's an absolute real achievement.

Premier also performed a little back-of-the-envelope math: if all 5,000 acute community hospitals made the same progress, 52,000 additional lives would have been saved.  Don Berwick and others would argue that these lives SHOULD be saved: it is not an achievement to save these lives, it is a necessity because all that is required is to implement evidence-based medicine. The professionals that work to deliver health care should offer no less.

Well -- how should that happen?  As Premier CEO Susan De Vore wrote on the RWJF blog, these results were achieved via a voluntary effort.  This is great for two reasons. One, we know what is achievable -- real lives and real money saved. Two, these aren't just academic medical centers in Boston or the Mayo Clinic in Minnesota. It included hospitals like Indian Path Medical Center near my in-laws' house in rural Tennessee. 

But I performed a little back-of-the-envelope math of my own.  157 participating hospitals represent 7.1% of all of Premier's 2,200 hospitals.  157 participating hospitals represent 3.1% of all acute community hospitals. These data tell us that this is a pilot project: good hospitals working on being great.  Yet it was quite limited in scope. 

How can we get other hospitals engaged?  It cannot be via voluntary effort.  The literature tells us that voluntary efforts fail. Not just kind of fail - really, really fail. 

The Premier data show that these reforms can take place.  Their press release notes that the participating hospitals were from 31 states and included urban and rural, large and small, and teaching and non-teaching facilities.  No one type of hospital was successful in implementing these quality improvements.  That's important. If there is a hospital in America that wants to put these reforms into action, chances are there is a Premier facility that would be willing to collaborate to help that hospital save lives and money.

To be sure, Premier has done an excellent job engaging hospitals that want to improve quality.  This summer, I posted on year four of their seminal P4P demonstration with CMS.  That initiative, like QUEST, shows us what can be accomplished.

Patients and taxpayers, though, deserve a country full of these hospitals, not a single digit smattering of hospitals.  To turn such voluntary efforts into mandatory ones, we need increased transparency and robust payment reform. It will save hundreds of thousands of lives over several years and billions of taxpayer dollars. The American people deserve no less.