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Voices for Safer Care

Insights from the Armstrong Institute

Humble beginnings

In early June, Dean Miller and Mr. Peterson announced the formation of the Armstrong Institute for Patient Safety and Quality. Since then, we have been busy, interviewing many of you, listening to your ideas and concerns, merging the Center for Innovation and the Quality and Safety Research Group into a single new entity. We are now ready to launch the work of the institute. The time could not be more urgent. Too many patients suffer preventable harm. Too often patients are insufficiently involved in their care, largely excluded from decision-making, inadequately informed on how to keep themselves well. Too much money is spent on therapies that don’t benefit patients and on treating complications that could have been prevented. The need to enhance the value of health care is a national priority.

The Armstrong Institute will work with you to change this. It will not be easy and it will need your help. Dr. Avedis Donabedian, the father of health care quality, was interviewed on his deathbed. A former student asked him, what is the secret of quality? Love, he responded. If you have love, you can work backward to fix the system. How right he was.

My mother recently had surgery for cancer on her eyelid. The staff loved deeply, providing a smile to comfort, a touch to heal, and listening to deeply understand. The clinicians displayed technical expertise, demonstrating the importance of advancing medical research. But despite caring nurses and technically competent surgeons, the waiting room was full of hazards. Elderly people pushed walkers over pumps, navigating obstacles that could trigger a fall, a fracture, their funeral.

I spent a week with my mom, watching, talking, listening. It was special to spend time with her. Yet I also learned the challenge we face providing high quality care. Clinicians care deeply, but they work in a system full of hazards, and they are constantly putting their patients at risk. Clinicians must work with managers, researchers and technical experts such as human factors and systems engineers to ensure patients receive the best possible outcomes. Top-down efforts won’t work. Clinicians must lead the way.

The institute will provide an infrastructure to improve patient safety and quality throughout Johns Hopkins Medicine, setting and implementing strategies across the board and advancing the science of patient safety. But we need a patient safety and quality infrastructure at every level, at the hospital level, department level, unit level and, most importantly, within individual clinicians and care teams. Patient safety and quality may start with the clinicians, but it doesn’t end there.

The institute’s vision, in a nutshell: Saving lives by leading the world in patient safety and quality care

Our mission is to continuously improve patient outcomes and enhance the value of care for all, around the world by advancing the science of patient safety and quality through discovery, implementation, education, evaluation, and collaborative learning.

The institute will:

  • become the world’s leader in patient safety research, training, and practice
  • embody the Johns Hopkins tripartite mission of research, patient care, and medical education by continuously improving clinical and patient outcomes at the lowest possible cost through discovery, evaluation and implementation of best practices, education and translation of this knowledge to populations across the world
  • oversee efforts to evaluate patient safety and quality of care throughout Johns Hopkins Medicine
  • collaborate with all patient safety and quality efforts at the JHM level
  • provide support to entity, departmental and faculty-led efforts to improve patient safety and quality
  • lead the development and implementation of a JHM strategic plan for patient safety and quality
  • be accountable for the JHM strategic plan for patient safety and quality
  • support scholarly activity of faculty in improving patient safety and quality
  • provide consultative services and technical support to JHM entities, departments and external partners
  • collaborate and work interdependently with external organizations to advance the science of patient safety and quality, improve patient outcomes and reduce costs of care.
  • advance health care delivery systems
  • provide programs and encourage structures that build organizational capacity within faculty and staff related to patient safety and improvement methods
  • build capacity within the Armstrong Institute, JHM entities, department/divisions, units and clinicians/staff/faculty to improve patient outcomes and add value
  • embed innovative strategies and solutions to improve patient outcomes

This is an exciting time for Johns Hopkins Medicine and we would love your feedback on how the institute can take quality of care to the next level. In future blog posts, I’ll provide details about the framework for the change we envision. We look forward to hearing from you.


Peter Pronovost

One of the world’s leading authorities on patient safety, Peter Pronovost served a the director of the Armstrong Institute, as well as senior vice president for patient safety and quality, at Johns Hopkins Medicine from 2011 until January 2018.

7 thoughts on “Humble beginnings”

  1. Peter; I remember when I was an Anesthesia resident and you were a SICU attending and how you always started Rounds with a "quote for the day". It brought humanity and often inspiration to the daily drudgery of Residency! I look forward to your blogs and admire your passion for patient safety and quality care. I was seriously harmed and almost died while hospitalized 2 years ago due to a safety omission. This is a real problem and I am proud of you and Hopkins for being at the forefront. Best wishes. Mary Beth Hanley

    1. Hi Mary Beth,
      great to hear from you. Sorry to hear about your hospital mishaps. Unfortunately they are still far too common and we need to change that.
      best of luck

  2. Peter,
    I am so thrilled about the work you have done to reduce medical errors, improve health care quality and increase patient centeredness. I too am passionately pursuing the same goals. I have developed the IACT Program for medical disclosure and transparency between doctors/hospitals and patients/families after unexpected adverse outcomes so that we may increase our ability to learn from these events and better meet the needs of those involved. Your combination of checklist, culture change and measurement is so powerful, I would very much like to tie our program in with what you are doing.
    I would love to discuss these ideas with you further. Congratulations on your election to the Institute of Medicine! We are so fortunate to have you pioneering this important work and now to have the support, recognition and platform you need to take it even further!
    Jessica Scott, MD, JD

    1. Hi Jessica
      thanks for the kind words. you are so correct, this approach can work for so many issues. the trick is to be sure we do measurment, checklist, and culture change. keep up the great work. there is so much to do

  3. How do you feel about the scrub wear policy? I think it is a bad practice, when I see doctors and nurses and other staff wearing Operating Room scrubs in the community. Certainly, you must have seen people wearing the O.R. scrubs at the grocery store, in restaurants, riding bikes, walking the dog, etc. I'd like to hear what you think about this issue.

    1. Dr. Pronovost, I am still hoping for a reply and I thought that this might be a topic that might be appropriate to this Blog. Do you think this is a safety issue?

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