A Department of Medicine Infrastructure for Patient Safety and Clinical Quality Improvement

Simon Mathews, Peter J. Pronovost, Elizabeth Daugherty Biddison, Brent Gray Petty, Mark Anderson, Terry S. Nelson, Katie Outten, Ronald Langlotz, Denice Duda, Carrie A Herzke, Kimberly Peairs, Sherita Hill Golden, Matthew B. Lautzenheiser, Hailey J. James, Sanjay Virendra Desai, Sara Keller, Leonard Feldman, Amit Kumar Pahwa, Stephen Berry

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Payers, providers, and patients increasingly recognize the importance of quality and safety in health care. Academic Departments of Medicine can advance quality and safety given the large populations they serve and the broad spectrum of diseases they treat. However, there are only few detailed examples of how quality and safety can be organized. This article describes a practical model at The Johns Hopkins Hospital Department of Medicine and details its structure and operation within a large academic health system. It is based on a fractal model that integrates multiple smaller units similar in structure (composition of faculty/staff), process (use of similar tools), and approach (using a common framework to address issues). This organization stresses local, multidisciplinary leadership, facilitates horizontal connections for peer learning, and maintains vertical connections for broader accountability.

Original languageEnglish (US)
JournalAmerican Journal of Medical Quality
StateAccepted/In press - Nov 1 2017


  • accountability
  • governance
  • quality and safety
  • quality management system

ASJC Scopus subject areas

  • Health Policy


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