Quality: Beyond 5 Million Lives

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The Institute for Healthcare Improvement tackles large-scale organizational improvement with its Improvement Map.

When the Institute for Healthcare Improvement introduced its 5 Million Lives Campaign in 2006, it marked a natural progression of the Cambridge, MA-based organization's patient safety programs. After the 100,000 Lives Campaign focused on reducing preventable deaths in U.S. hospitals, the IHI expanded its efforts by endeavoring to protect patients from 5 million incidents of medical harm in a two-year period.

But if 5 Million Lives targeted a wider swath of the patient safety spectrum, the IHI's latest initiative aims for an even more ambitious goal that stretches beyond the prevention of deaths and harm: comprehensive hospitalwide quality improvement. "If we look at our progress over the past four years, there were pockets of really stunning success with the 100,000 Lives Campaign and with 5 Million Lives," says Joe McCannon, vice president of IHI. "But we need to find ways to make that change more ubiquitous and help organizations move from success in clinical areas to organizationwide progress."

The IHI's answer is the Improvement Map, a tool that's designed to help hospital and health system leaders prioritize the myriad regulations and demands that deluge their organizations on a daily basis, streamline essential processes, and devise organization-specific improvement plans, says McCannon. "The map moves from specific clinical interventions to what we believe would be the consolidated set of 80, maybe 100 things that would lead to transformative performance for the entire organization," he says. "It may seem counterintuitive to say we're consolidating by asking people to do 80 things, but in fact, the goal is that this would represent a simplification of the many demands and requests that are being made of hospitals."

How will they do it?

So how will hospital leaders be expected to focus on dozens of process improvement areas simultaneously? They won't, says McCannon. "It wouldn't be possible to ask them to address 80 areas of care at once. But what we can say is, ‘Here's a system for prioritizing.'"

National conference calls, mentor hospitals that act as coaches, links to new tools and advice, and intensive Web-based counseling sessions are all components of the IHI's efforts to help hospitals with that prioritization, says McCannon. Beyond those broad techniques, the Improvement Map adds three new specific interventions to the 12 from the 5 Million Lives Campaign:

  • Have every 5 Million Lives hospital test the World Health Organization's Surgical Safety Checklist in at least one operating room.
  • Prevent catheter-associated urinary tract infections.
  • Link quality and financial management by creating strategies to engage the chief financial officer and provide value for patients.

The IHI has placed the most urgency on the WHO checklist, a 19-item list that includes everything from fundamental confirmations of surgical sites and patient identity to labeling specimens and documenting equipment problems. At the IHI's National Forum on Quality Improvement this past December, President and CEO Donald Berwick, MD, asked hospitals to test the list by the beginning of this month.

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