Andrea Kabcenell

Reducing adverse drug events: lessons from a breakthrough series collaborative.

BACKGROUND In January 1996, 38 hospitals and health care organizations (for a total of 40 hospitals) in the United States came together in an Institute for Healthcare Improvement (IHI; Boston) Breakthrough Series collaborative to reduce adverse drug events-injuries related to the use or nonuse of medications. METHODS The participants were taught the Model for Improvement, a method for rapid-cycle change and evaluation, and were then coached on how to identify their own problem areas and develop changes in practice for rapid-cycle testing. These changes could be implementation of one or more known medication error prevention practices or new practices developed. RESULTS During a 15-month period the 40 hospitals conducted a total of 739 tests of changes. Process changes accounted for 63% of the cycles; the remainder consisted of preliminary data gathering, consensus-building, or education cycles. Eight types of changes were implemented by seven or more hospitals, with a success rate of 70%. These changes included non-punitive reporting, ensuring documentation of allergy information, standardizing medication administration times, and implementing chemotherapy protocols. DISCUSSION Success in making significant changes was associated with strong leadership, effective processes, and appropriate choice of intervention. Successful teams were able to define, clearly state, and relentlessly pursue their aims, and then chose practical interventions and moved early into changing a process. They did not spend months collecting data before beginning a change. Changes that were most successful were those that attempted to change processes, not people. Health care organizations committed to patient safety need not regard current performance limits as inevitable.

Pursuing Perfection: An Interview with Don Berwick and Michael Rothman

: Don Berwick and Michael Rothman discuss the Pursuing Perfection initiative, which is intended to help health care organizations integrate improvement work into day-to-day life, with systemwide changes in infrastructure, project management, care, and leadership.

Lessons in Cooperation: An Update on Improving the Quality of Hospital Care

BACKGROUND Between 1989 and 1997 the Robert Wood Johnson Foundation (Princeton, NJ) launched a demonstration project, the Improving the Quality of Hospital Care Program, to test a consortium approach to quality improvement. As part of the project, four hospital consortia in various parts of the United States shared quality resources (for example, training) and collaborated on improvement efforts. Although cooperation was not a natural approach for enhancing quality in hospitals, the consortia mounted improvements in multiple clinical areas, such as diabetes care, the intensive care unit (ICU), prevention of wound infections, and care in rural areas. WHERE ARE THEY NOW? Of the four consortia that received implementation funding, all are continuing some explicit focus on improving quality, but only two have retained the organizational form of a consortium. Based at the University of Iowa (Iowa City), the Institute for Quality Healthcare continues to operate as a free-standing consortium with more than 40 hospital members. The Vermont Program for Quality in Health Care (Montpelier) provides information and education to improve quality of care statewide. LESSONS FROM THE PROGRAM The program taught valuable lessons about what hospitals can do together and what they can achieve when they cooperate around quality of care issues. Sharing resources for education, providing a forum for quality improvement professionals to work together on specific issues, and identifying means of improving specific aspects of care in the group are all feasible in the consortium model. Even a chaotic environment can support cooperation.