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Voices for Safer Care

Insights from the Armstrong Institute

Voices for Safer Care Home Measurement of Safety and Quality A blueprint for high reliability

Ensuring that patients who take beta blockers receive their heart medication before and after surgery is a best practice to prevent future problems. A workgroup at The Johns Hopkins Hospital is one of 40 teams across JHM focused on delivering such best practices.

Across health care, organizations constantly struggle with the challenge of achieving patient safety and quality successes on a large scale—across a hospital or network of hospitals. Too often, they are doomed at the start, because staff don’t even know what the goals are. In other cases, staff have limited capacity to carry out improvement work and few resources available to help them. Subpar performance is allowed to continue without any accountability, assuming that they know how well they are performing in the first place.

At Johns Hopkins Medicine, we are proud of an effort that has not only improved patient care, but has also provided a blueprint for how we can tackle any number of challenges in improving patient care—such as eliminating infections or enhancing the patient experience—across complex health care organizations.

Last week three hospitals within Johns Hopkins Medicine were recognized by the Joint Commission as “Top Performers” in patient safety and quality, for consistently following evidence-based practices at a very high level. Those hospitals—The Johns Hopkins Hospital in Baltimore, Sibley Memorial Hospital in Washington, D.C. and All Children’s Hospital in St. Petersburg, Fla.—benefitted from an organization-wide approach that enlisted local teams in problem solving, directed core resources to support those teams, and made units, departments and hospitals accountable for their performance.

Through this work, we at the Armstrong Institute for Patient Safety and Quality have developed a conceptual framework for improvement work that can be applied to other challenges. That includes four key tenets:
• Clearly communicate goals and measures
• Build capacity using Lean Sigma and improvement science
• Transparently report results and create accountability process
• Create sustainability plan

Workgroups were formed for different sets of core measures, and each workgroup was paired with a faculty member and quality improvement coach. The faculty members provided patient safety expertise in their fields while the coaches trained in Lean Sigma performance improvement methods helped teams identify barriers to improvement and devise solutions.

To support transparency and accountability, each clinical unit, department and hospital was responsible for reporting on its performance. When performance failed to meet the goals, the team’s performance would be reviewed at progressively higher levels of the organization until it reached the target. Hospital presidents were responsible for reporting performance to boards of trustees, ensuring accountability from the board room to the bedside.

You can learn more about our approach in the December 2013 issue of The Joint Commission Journal on Quality and Safety, which has granted us permission to share the article ahead of print. Read more here.

This describes an approach that will hopefully support other hospitals in their work to deliver safe, high-quality care.

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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.

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