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REMARKS BY:	DONNA E. SHALALA, SECRETARY OF HEALTH AND HUMAN SERVICES
PLACE:		Commonwealth Fund Welcoming Dinner, Blair House, Washington, DC
DATE:		October 11, 2000

Improving Health Care Quality

It's my sincere pleasure to welcome all of you again-and for my last time as Secretary of Health and Human Services-to Blair House. I can't think of a better place to hold this Commonwealth Fund dinner than here in the President's guest house for two reasons. First, because all the stories regarding the purchase of Blair House have one thing in common: They all involve Winston Churchill. The most famous claims that, early one morning, Eleanor Roosevelt found the prime minister wandering around the White House, puffing his ever-present cigar-and still in his night shirt. Churchill demanded to see the President.Shortly after, Eleanor demanded a guest house.

And second-thanks to Mr. Churchill and Mrs. Roosevelt-for over half-a-century, Blair House has not only provided shelter for the President's guests, it has promoted an atmosphere of international cooperation. In fact, two of this century's cornerstones of international cooperation-the Marshall Plan and the Truman Doctrine-were born right here in the dining room during the tenure of Franklin Roosevelt's successor, Harry Truman.

Truman was the Blair House's longest guest-staying for four years while the White House was being renovated. Unfortunately, not all of his memories of that time were happy ones. Exactly fifty years ago, gunmen tried to assassinate Truman here at Blair House. After the incident, the seemingly unflappable Harry calmly remarked, "A President has to expect those things. The only thing you have to worry about is bad luck."

Bad luck in health care is something that no patient-in any of our countries-should ever have to worry about. That's why this conference on health care quality and innovation is so important. We need to take every opportunity to talk to each other and to learn from each other about how to measure quality.to improve quality.and to guarantee quality. Our ultimate goal must be to ensure that-in all of our countries, and in every situation-the right patient, gets the right treatment, at the right time, and in the right way. This won't be easy. We all have a long way to go to reach that goal. That's a lesson we've certainly learned here in the United States.

Four years ago, President Clinton created the Health Care Quality Commission-which I co-chair-and asked us to take a long, hard look at the current state of quality. We identified three overall problems. First, there are too many errors being committed. The Institute of Medicine's report on medical errors-To Err is Human-indicates that, annually, between 50,000 and 100,000 hospital patients in the United States die from medical errors. It's the eighth leading cause of death in this country. Second, there's a great deal of over- and under-utilization of health care services. For example, About 80,000 women get unnecessary hysterectomies every year.while an estimated 180,000 Americans die because they don't receive beta blockers after their first heart attack. Finally, there's a tremendous variation in national, regional and local health care services offered in this country.

To varying degrees, all of our countries are facing these same problems. Over the next three days, we have the opportunity to specifically address these problems.and to help chart a common course in our common cause.

Improving quality is what our health care systems need-and what our patients deserve and demand. And we must act now. The urgency reminds me of one other anecdote involving Churchill. In the early days of the blitz-and not long after his encounter with Mrs. Roosevelt-Churchill traveled to Canterbury to see that the proper precautions were being taken to safeguard the famous cathedral. Speaking to the Archbishop he explained, "No matter how many close hits the Nazis make-I'm sure that the cathedral will survive." "Yes," the archbishop said with obvious unease, "But what if they score a direct hit on us?" "My dear Archbishop," replied the prime minister in an especially soothing manner, "then you will have to regard it as a summons."

Improving quality is our summons.our call to action.our challenge and charge. One person who certainly understands this is our keynote speaker, Canadian Health Minister, Allan Rock. As many of you are aware, Minister Rock first served as justice minister, where he was instrumental in getting significant gun control legislation on the books. Now, as health minister, he's improved quality; significantly increased health care funding; and implemented far reaching tobacco legislation. As part of the new tobacco laws, 50 percent of each cigarette package must feature a "picto-gram," which graphically demonstrates the effects of smoking on health and the body. Among the photos of diseased lungs and hearts, I've been told that the most popular-and famous-is the simple-drooping cigarette.I've also been told-and assured-that this image simply refers to the drooping prospects of male smokers. And now it's my pleasure to introduce an outstanding colleague, Canadian Health Minister Allan Rock.

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