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The Map to Improved Care is a Complex One

Jay Moore, for HealthLeaders Media, December 18, 2008

How many processes contribute to the quality of care provided in your hospital? How many measures does your organization report to someone in a given year? How many complex requirements must your hospital decipher? Contemplating such migraine-inducing questions can make a hospital leader want to hide in a dark room and lie down for a while. The sheer volume of often conflicting demands placed upon provider organizations—coupled with a deteriorating financial climate—can make the notion of improving care quality seem like an idealistic improbability at best, an impossibility at worst. Is true quality improvement a realistic goal in healthcare's current landscape?

Although I'm sure many executives whose hospitals have been deluged with bad news for months are pretty skeptical right now, the Institute for Healthcare Improvement contends the answer is yes. At the IHI's annual National Forum on Quality Improvement in Health Care last week, President and CEO Donald Berwick, MD, outlined the IHI's "Improvement Map," the organization's latest initiative designed to help hospital leaders sift through myriad regulations, measurements, and demands to hone an essential set of processes and craft an organization-specific plan for quality improvement. "You've got to face away from the chaos and toward the purpose," Berwick told attendees during his keynote address.

An ambitious concept, to be sure. The IHI's 100,000 Lives and 5 Million Lives Campaigns focused specifically on protecting patients from incidents of medical harm; the Improvement Map concentrates on "the entire landscape of outstanding hospital care," according to the summary provided in the conference materials. Berwick said the map will address "a master, overarching agenda of processes."

Sounds good, I suppose—but what kinds of specifics lie beneath the feel-good generalities? There aren't that many to be had at this point. The map does add three new interventions to the 12 from the 100,000 Lives and 5 Million Lives Campaigns:

  • Adopt the World Health Organization Surgical Safety Checklist.
  • Prevent catheter-associated urinary tract infections.
  • Link quality and financial management: strategies to engage the chief financial officer and provide value for patients.

Berwick challenged every hospital in the 5 Million Lives Campaign to adopt the WHO Surgical Safety Checklist in at least one operating room within the next 90 days. A "sprint," Berwick called it. The map will also "continue to develop as we learn the shortest routes to the best outcomes. IHI will add interventions over time, clustering them by care setting and content area, and will help hospitals identify where they should focus to maximize impact," according to the summary.

My inclination, I confess, is to be cynical about all of this. Passionate calls to action are common healthcare conference fare. The Improvement Map is still in development, so measuring its potential impact is difficult, to say the least. Yes, the 100,000 Lives and 5 Million Lives Campaigns have made meaningful strides in reducing needless deaths—but a grand objective like covering "the entire landscape of outstanding hospital care" is another matter. And asking every 5 Million Lives hospital to adopt the safety checklist within 90 days? That's more than 4,000 hospitals.

But all of that said, I'm vowing to set aside those skeptical instincts (for now, at least). Because while I'll be watching closely as the program develops, I agree with a deceptively simple premise of the Improvement Map—that you can't implement improvements in a genuinely meaningful way if the fundamental processes intended to create those improvements are flawed. In theory, this is a concept hospital leaders have understood for a long time. In practice, it's a concept that challenges organizations across the country every day. Whether the IHI's newest initiative will be the answer is highly debatable. But merely saying "That will never work" doesn't solve anything.


Jay Moore is managing editor for HealthLeaders magazine. He can be reached at jmoore@healthleadersmedia.com.
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