Insights from the Armstrong Institute
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.
I hope you’ll take the time to check out our podcast project, The Heart of Caring, which highlights stories that deepen our understanding of patient-… Read More »Patient-centered care means treating the individual
Last year, Sarah Andryauskas, then a new nurse in our emergency department, was caring for a patient with diabetes who had trouble maintaining healthy blood glucose levels. His disease had contributed to several hospital visits over the preceding months and years.
As health care providers, it’s tempting to attribute such repeat visits to patient noncompliance. But Sarah took the time to ask: Was there a barrier that kept the man from taking control of his health? Indeed there was, as the patient explained that diabetes-related sight loss had made it impossible to read his glucometer—and thus to manage his blood sugar.
Sarah’s story of this revelation, and the extraordinary steps that she and a colleague took to find a glucometer that reads results out loud, is the first in a new podcast series that delves into what it truly means to practice “patient- and family-centered care.”
Read More »Tell your story: Excellence in patient- and family-centered care
My daughter just asked me what I was thankful for this Thanksgiving. As I reflected on the blessings in my family and personal life, I also thought about what I was grateful for in patient safety. While progress has been slower than any of us would want, we certainly have many things to count:
Patient- and family-centered care is getting long-overdue attention. About two years ago, nurses on one unit at the Johns Hopkins Children’s Center began conducting shift-change reports in patients’ rooms, rather than in the hallway, so that patients and family members have the chance to ask questions and get the most up-to-date information. More hospitals are including patients on committees. These are small changes, but they represent a larger acknowledgement of the importance of building care around patients’ needs and to seek their wisdom.
Clinicians are increasingly engaged in the work of patient safety. In the past they have largely stayed on the sidelines or have pushed back—often appropriately—against regulatory mandates, interventions or measures that are not informed by science. Yet clinicians did not step forward to take the lead. Now they are. Professional societies, physicians, researchers, nurses, want the science to be good, the measures to be wise, and the interventions flexible enough to fit into their local context. Over the last two weeks, I had calls with several professional societies planning safety programs. At Hopkins, more than 100 faculty members recently showed up at a meeting for those interested in conducting patient safety research.
I recently gave a talk to the American Medical Student Association. The energy in the room was palpable. The students were excited, passionate and hopeful. We spoke about the urgent need to reduce preventable harm and to enhance value, and we discussed that they will need to be the ones to lead these efforts.
Yet, in speaking with them, I had to confront the sad reality that most of them will graduate ill-prepared to lead the improvements of quality and safety our health care system needs. They no doubt will know chemistry, biology and physiology, but they may not know about human factors, implementation science or performance measurement—the language of quality improvement. They will know orthopedics and genetics but they won't know teamwork and systems engineering. They likely know about German scientist Rudolph Virchow, the father of cell theory, yet they do not know John Kotter, the father of change theory whose model for leading change is highly effective and widely used. Without a doubt, these students will need to lead change.
Read More »Part II: ISO clinician leaders in patient safety and quality
Caregivers’ potential to reduce preventable harm and improve patient outcomes is profound. Consider the news that came out of Spain last week from a collaborative… Read More »Translating safety in Spain
WANTED: Clinicians for long-term relationship to lead unit and department safety efforts. Must be passionate about improving patient outcomes and value, have skills needed to lead these efforts, and enjoy working as part of a team.
Dr. Martin Luther King, Jr., in pushing the civil rights agenda, spoke of the "fierce urgency of now." Recent news reports highlight the fierce urgency of now in health care. The U.S leads the developed world in preventable deaths, as preventable harm continues unabated, insurance premiums have increased 9 percent while GDP remains flat, and investments in health care are crowding out investments in other important areas such as K-12 education. The fierce urgency to improve health care value not only impacts patients and health care providers, but all of society.
There are two main reasons why progress in improving safety and quality has been slow and difficult. The first is the field has largely run away from science, seeking quick fixes rather than deep understanding, focusing on what we do rather than the results we produce. The second reason is that health care lacks the capacity (infrastructure with skilled people) to improve quality and value. Because we have treated patient safety and quality as a project rather than a way of life, we have failed to create the necessary infrastructure to support the needed quality efforts.
If we are to improve quality, we will need to create an infrastructure to support patient safety. It is not surprising that most of the published literature in quality and safety comes from units (such as intensive-care units) that have dedicated physician and nurse leaders; there is someone in place to closely manage the work. Research and experience shows that units with dedicated physician leaders have lower costs, higher quality and better patient satisfaction.
Read More »ISO clinician leaders in patient safety and quality
In creating the Armstrong Institute, we reviewed the Johns Hopkins Medicine values, trying to see if these were sufficient for our new endeavor and considering if we might need some new ones. Much to my surprise, no one among the 50 people in the room - myself included - could state the values off top of our head. So we looked them up:
Johns Hopkins Medicine Core Values
We then realized that the words themselves were not important. What was important was what the words meant to each of us. We asked everyone to describe how they would behave if they lived these values. The answers, understandably, varied whether the responder was a researcher, a community physician, a nurse, a member of the patient safety staff, an administrator, a house keeper. Yet, if Hopkins is to advance patient safety, all of us must live these values in our own way.
"I have a complicated medical situation that involves neurologists, surgeons, obstetricians, specialized ophthalmologists and others. I was at Johns Hopkins and very lucky to be because I had some of the best doctors in the country. What really struck me, though, was that each specialist was really very narrowly focused and really ne'er the twain did meet. I felt like it was up to me to put the pieces together into some kind of sensible picture in order to move forward to greater health. I will note that, for the most part, they had great bedside manner.”
Rhonda Wyskiel, an ICU nurse and staff member with the Armstrong Institute, was one of the guests on The Kojo Nnamdi Show last week when the radio host read these words from an e-mail, penned by a woman named Anne. Rhonda, one of three guests who appeared on the NPR-affiliated program to discuss the challenges of providing patient-centered care, acknowledged that this writer’s experience was common, and she empathized with Anne. As Rhonda pointed out, there are efforts at the hospital and national level to better coordinate care so that patients can have a central contact for when they have questions. For instance, in some ICUs, there is an intensivist who coordinates a patient’s care in that environment.
But Anne points out a problem that eats away at the quality of care that hospitals provide and leaves patients feeling confused: Too often, care is organized around providers rather than patients.
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… Read More »Humble beginnings