No, Dorothy, there is no wizard. We can't click our heels together and make patient care safer, and we can't click our heels together to balance the budget. Patient Safety, Quality Improvement, and all Financial Stewardship require hard work....every day.
I bundle these together for many reasons.
First, they are indeed intricately connected. We know that unsafe, ineffective, inefficient, or poorly timed care is not just bad care, it is wasteful care. Many of us grew up in the era where we were constantly told that more care = better care. We know better now. Better care = better care, and better care is often less care, especially if the "more care" comes from trying to get it right a second time.
Second, I recently was at IHI where Dr. Berwick eloquently talked about the two choices we all have...to fight to continue to make care safer over the next twenty years, or to give up because it is too hard and because the returns on our hard work and emotional committment are often too elusive. And then I returned to Contra Costa and California where we are faced with astronomical budget deficits. We will need to answer Dr. Berwick's question within this economic context.
So what's my answer? Giving up is not an option. We will work together to continue to improve the quality of the care we give. It will not be easy, and there will be tough choices, but giving up is not one of them.
And clicking our ruby slippers is not an option either.