Creating a high-reliability health care system: Improving performance on core processes of care at johns hopkins medicine

Peter J. Pronovost, C. Michael Armstrong, Renee Demski, Tiffany Callender, Laura Winner, Marlene R. Miller, John Matthew Austin, Sean Berenholtz, Ting Yang, Ronald R. Peterson, Judy A. Reitz, Richard G Bennett, Victor A. Broccolino, Richard Davis, Brian A. Gragnolati, Gene E. Green, Paul B Rothman

Research output: Contribution to journalArticle

Abstract

In this article, the authors describe an initiative that established an infrastructure to manage quality and safety efforts throughout a complex health care system and that improved performance on core measures for acute myocardial infarction, heart failure, pneumonia, surgical care, and children's asthma. The Johns Hopkins Medicine Board of Trustees created a governance structure to establish health care system-wide oversight and hospital accountability for quality and safety efforts throughout Johns Hopkins Medicine. The Armstrong Institute for Patient Safety and Quality was formed; institute leaders used a conceptual model nested in a fractal infrastructure to implement this initiative to improve performance at two academic medical centers and three community hospitals, starting in March 2012. The initiative aimed to achieve ≥ 96% compliance on seven inpatient process-of-care core measures and meet the requirements for the Delmarva Foundation and Joint Commission awards. The primary outcome measure was the percentage of patients at each hospital who received the recommended process of care. The authors compared health system and hospital performance before (2011) and after (2012, 2013) the initiative. The health system achieved ≥ 96% compliance on six of the seven targeted measures by 2013. Of the five hospitals, four received the Delmarva Foundation award and two received The Joint Commission award in 2013. The authors argue that, to improve quality and safety, health care systems should establish a system-wide governance structure and accountability process. They also should define and communicate goals and measures and build an infrastructure to support peer learning.

Original languageEnglish (US)
Pages (from-to)165-172
Number of pages8
JournalAcademic Medicine
Volume90
Issue number2
DOIs
StatePublished - Feb 6 2015

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Medicine
medicine
health care
Delivery of Health Care
Social Responsibility
Safety
Compliance
performance
Joints
infrastructure
Trustees
Fractals
Quality of Health Care
Community Hospital
Health
Patient Safety
Child Care
governance
Inpatients
Pneumonia

ASJC Scopus subject areas

  • Medicine(all)
  • Education

Cite this

Creating a high-reliability health care system : Improving performance on core processes of care at johns hopkins medicine. / Pronovost, Peter J.; Armstrong, C. Michael; Demski, Renee; Callender, Tiffany; Winner, Laura; Miller, Marlene R.; Austin, John Matthew; Berenholtz, Sean; Yang, Ting; Peterson, Ronald R.; Reitz, Judy A.; Bennett, Richard G; Broccolino, Victor A.; Davis, Richard; Gragnolati, Brian A.; Green, Gene E.; Rothman, Paul B.

In: Academic Medicine, Vol. 90, No. 2, 06.02.2015, p. 165-172.

Research output: Contribution to journalArticle

Pronovost, PJ, Armstrong, CM, Demski, R, Callender, T, Winner, L, Miller, MR, Austin, JM, Berenholtz, S, Yang, T, Peterson, RR, Reitz, JA, Bennett, RG, Broccolino, VA, Davis, R, Gragnolati, BA, Green, GE & Rothman, PB 2015, 'Creating a high-reliability health care system: Improving performance on core processes of care at johns hopkins medicine', Academic Medicine, vol. 90, no. 2, pp. 165-172. https://doi.org/10.1097/ACM.0000000000000610
Pronovost, Peter J. ; Armstrong, C. Michael ; Demski, Renee ; Callender, Tiffany ; Winner, Laura ; Miller, Marlene R. ; Austin, John Matthew ; Berenholtz, Sean ; Yang, Ting ; Peterson, Ronald R. ; Reitz, Judy A. ; Bennett, Richard G ; Broccolino, Victor A. ; Davis, Richard ; Gragnolati, Brian A. ; Green, Gene E. ; Rothman, Paul B. / Creating a high-reliability health care system : Improving performance on core processes of care at johns hopkins medicine. In: Academic Medicine. 2015 ; Vol. 90, No. 2. pp. 165-172.
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