In 2006, the Institute for Healthcare Improvement (IHI) launched the 5 Million Lives Campaign, a nationwide quality initiative to significantly reduce levels of morbidity and mortality in the United States. IHI quantified this aim by asking hospitals that participated in the Campaign to prevent 5 million incidents of medical harm by adopting 12 patient safety interventions over a two-year period (Berwick, 2014). In response to the Campaign, Arrowhead District Hospital, a 374-bed medical facility located in the Midwestern part of the United States, created the Quality of Care Committee (QCC). The QCC was launched in an effort to enhance accountability for delivery of quality care through the following strategies:
- Improve performance in clinical quality as reflected in the core measures.
- Reduce mortality through the adoption of best practices.
- Improve accountability across the organization and its various departments and units.
- Improve the comprehensiveness and timeliness of the peer review process.
- Improve patient satisfaction.
- Foster a culture of patient safety.
One of the first steps taken by the QCC was to educate the executive leadership team about key quality initiatives and metrics, and inform the medical staff about the credentialing and reappointment process, and patient satisfaction. To enhance leadership and QCC member competency, the QCC made a commitment to continuous learning, and sought knowledge about best practices and the principles of quality improvement. Several QCC members, physicians, and executive leaders made a site visit to a best practice facility and met with their leadership team to learn about their hospital’s keys to achieving top performance results. In addition, Arrowhead’s Board members attended IHI and Leapfrog Group conferences, which focused on the role of governing boards in driving quality outcomes. For example, an ongoing commitment to education is demonstrated not only through conference attendance, but also through the regular provision and discussion of pertinent literature at each Board meeting (Rubino, Esparza, & Chassiakos, 2014).
The QCC explored and supported the adoption of several innovative strategies to foster a culture of quality and safety. These included crew resource management (CRM), QCC rounding, and the “Just Culture” approach to errors. The CRM model was originally developed by the aviation industry in response to critical and fatal errors by a flight team. It has since been adapted for use in healthcare from the techniques used by aerospace cockpit crews to promote effective teamwork and structured communication for enhanced patient safety (McConaughey, 2008). QCC members also began conducting rounds throughout the hospital prior to its monthly meetings. The rounds were used to create greater visibility for executive leadership’s commitment to quality care, and provide an opportunity for QCC member to assess and validate the deployment of effective, patient/family-centered and evidence-based care practices at the bedside. Rounds have been made to various Arrowhead departments and units to interact with frontline staff, physicians, and managers, and evaluate progress using tracer methodology (Schmidt, 2014, April 21). Patient “tracers” were developed by The Joint Commission as a means to evaluate a patient’s care across the continuum of care in order to evaluate compliance to accreditation standards. Some areas assessed during rounds were core measures processes, pressure ulcer prevention, emergency department (ED) and hospital throughout, and the case management/patient discharge process (The Joint Commission, 2017, February 10). “Just Culture” error reporting is an approach that shifts attention from retrospective judgment of others to real-time evaluation of behavioral choices in a rational and organized manner. A just culture balances the need for an open and honest reporting environment with the end of a quality learning environment and culture. While the organization has a duty and responsibility to employees (and ultimately to patients), this approach emphasizes that all employees are held responsible for the quality of their choices. Just culture requires a change from focusing on errors and outcomes to system design and management of the behavioral choices of all employees (Boysen, 2013).
In the years since its inception, the QCC has led efforts to engage physicians by creating aligned incentives such as the incorporation of performance goals in physician administrative contracts and the referral of core measure fall-outs for peer review. The QCC has supported physician leadership in their oversight of medical staff credentialing, proctoring, and tracking f medical staff performance data as part of their ongoing professional practice evaluation process. To ensure continued focus on the patient and family experience, a family member representative was added to the QCC as a voting member. To reinforce leadership accountability across the organization, the QCC invited department managers and directors to the QCC meetings to communicate their plans for improving their area’s performance if their results were falling below the established benchmarks.
As a result of these efforts, Arrowhead District Hospital demonstrated significant improvements, including a 25% reduction in mortality, improved core-measure perfect-care score, ED and hospital throughput improvement, a shift to performance-based medical staff reappointment, and the sharing of their best practices with others through publications in peer-reviewed, scholarly journals (Rubino, Esparza, & Chassiakos, 2014).
Using a systems thinking approach, keeping in mind that every action in the hospital results in a reaction somewhere else the facility, answer the following questions:
- Which of the key strategies adopted by the QCC do you think are the most effective for ongoing quality improvement? Explain your rationale.
- What additional rounds can you suggest for QCC members besides the ones already mentioned? Why?
- What other measures can be used to assess the quality of care being delivered at Arrowhead District Hospital? Support your recommendations.
Length: 2–3 pages (excluding title page, references page, and any appendices)
References: Include a minimum of 3 peer-reviewed, scholarly resources.
Your assignment should demonstrate thoughtful consideration of the ideas and concepts that are presented in the course and provide new thoughts and insights relating directly to this topic. Your assignment should also reflect graduate-level writing and APA standards (6th edition). Be sure to adhere to University’s Academic Integrity Policy.
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Berwick, D. M. (2014). Promising care: how we can rescue health care by improving it. San Francisco: Jossey-Bass.
Boysen, P. G. (2013). Just culture: a foundation for balanced accountability and patient safety. Ochsner Journal, 13(3), 400-406.