Avoidable Harm

The Institute for Healthcare Improvement’s 100,000 Lives campaign was yet another step in the drive to revolutionize patient safety. The next logical extension was to look away from avoidable patient deaths and focus on improving the rates of avoidable patient harm.

But Donald M. Berwick, M.D., president and chief executive officer of Cambridge, Mass.-based IHI, is quick to point out that while the IHI wants its new 5 Million Lives campaign to build on lessons learned from the 100,000 Lives program, there is a caveat. “The new campaign is not premised by the certitude that 100,000 lives were saved,” Berwick says. “We do think mortality has fallen. We have seen fantastic success in buoyancy and commitment. For example, literally dozens of hospitals have gone with no ventilator pneumonias, which is very exciting for us.”

Berwick notes that the interventions in the 100,000 Lives campaign actually “prevented more injuries than they saved lives.” What the two campaigns share are proven methodologies that are translatable. Berwick recalls, for example, that when the Agency for Health Care Policy and Research, the predecessor to the Agency for Healthcare Research and Quality, was commissioned to do a study of protocols for pressure ulcers, the result was a 40-page manual.

The new 5 Million Lives interventions include:

• Prevent harm from high-alert medications, including anticoagulants, sedatives, narcotics and insulin.
• Reduce surgical complications by implementing all of the changes recommended by the Surgical Care Improvement Project (www.medqic.org/scip).
• Prevent pressure ulcers by using science-based guidelines for their prevention.
• Reduce methicillin-resistant staphy- lococcus aureus (MRSA) infection by reliably implementing scientifically proven infection control practices.
• Deliver reliable, evidence-based care for congestive heart failure to avoid readmissions.

Success in using any of the IHI’s interventions comes from adopting “the concept of reliability,” says Joseph McCannon, IHI vice president. “It’s not that clinicians don’t know what to do,” McCannon says. “But how do you get it to happen 100 percent of the time? And it’s not a question of knowledge or will, but how do you create the systems to make it happen?”

From a practical standpoint, McCannon says none of the new initiatives are necessarily going to require much in the way of a commitment of new resources; many if not most hospitals already have done work in these areas. “This is about redesigning the existing processes,” he says. “We looked very hard to align with other things they are doing. We are not way out on a limb here.”

The sixth new intervention, and the one that strays from the patient safety-centric focus of the other interventions, is the IHI’s call to “get boards on board” by “defining and spreading the best-known leveraged processes for hospital boards of directors, so that they can become far more effective in accelerating organizational progress toward safe care.” Berwick says the IHI learned in the 100,000 Lives campaign that implementing things like rapid response teams requires a high-level of commitment from the leadership of the organization—and that not all boards are ready for such commitments. The goal is for boards to view the data from the quality team in the same way that they would view dashboards from the finance department. But to get there requires a shift that IHI hopes to foster. “If the science guys say this is the proper way to do it, that represents a culture change in the organization.”

Responsibility for board management will fall on the CEO and executive leadership team, and Berwick says the CEO’s first step is simply “to say this is important, and we need to get it done.” But Berwick is already seeing the transition from the “traditional board that manages the business” to boards that are very curious about quality and transparency. “You’d have to be asleep not to see that coming down the tracks.”

Jim Molpus is editor of HealthLeaders magazine and HealthLeaders Online News. He may be reached at jmolpus@healthleadersmedia.com.