Establishing an Ambulatory Medicine Quality and Safety Oversight Structure: Leveraging the Fractal Model

Steven J Kravet, Jennifer Bailey, Renee Demski, Peter Pronovost

Research output: Contribution to journalArticle

Abstract

PROBLEM: Academic health systems face challenges in the governance and oversight of quality and safety efforts across their organizations. Ambulatory practices, which are growing in number, size, and complexity, face particular challenges in these areas. APPROACH: In February 2014, leaders at Johns Hopkins Medicine (JHM) implemented a governance, oversight, and accountability structure for quality and safety efforts across JHM ambulatory practices. This model was based on the fractal approach, which balances independence and interdependence and provides horizontal and vertical support. It set expectations of accountability at all levels from the Board of Trustees to frontline staff and featured a cascading structure that reached all units and ambulatory practices. This model leveraged an Ambulatory Quality Council led by a physician and nurse dyad to provide the infrastructure to share best practices, continuously improve, and define accountable local leaders. OUTCOMES: This model was incorporated into the quality and safety infrastructure across JHM. Improved outcomes in the domains of patient safety/risk reduction, externally reported quality measures, patient care/experience, and value have been demonstrated. An additional benefit was an improvement in Medicaid value-based purchasing metrics, which are linked to several million dollars of revenue. NEXT STEPS: As this model matures, it will serve as a mechanism to align quality standards and programs across regional, national, and international partners and to provide a clear quality structure as new practices join the health system. Future efforts will link this model to JHM’s academic mission, enhancing education to address Accreditation Council for Graduate Medical Education core competencies.

Original languageEnglish (US)
JournalAcademic Medicine
DOIs
StateAccepted/In press - Jan 27 2016

Fingerprint

Fractals
Social Responsibility
Medicine
medicine
Safety
Value-Based Purchasing
Graduate Medical Education
Trustees
Accreditation
Medicaid
Health
Risk Reduction Behavior
Patient Safety
Practice Guidelines
Patient Care
Nurses
Organizations
Physicians
Education
regional program

ASJC Scopus subject areas

  • Medicine(all)
  • Education

Cite this

Establishing an Ambulatory Medicine Quality and Safety Oversight Structure : Leveraging the Fractal Model. / Kravet, Steven J; Bailey, Jennifer; Demski, Renee; Pronovost, Peter.

In: Academic Medicine, 27.01.2016.

Research output: Contribution to journalArticle

@article{2081990b6e5f4f278d0e86b24e92eb90,
title = "Establishing an Ambulatory Medicine Quality and Safety Oversight Structure: Leveraging the Fractal Model",
abstract = "PROBLEM: Academic health systems face challenges in the governance and oversight of quality and safety efforts across their organizations. Ambulatory practices, which are growing in number, size, and complexity, face particular challenges in these areas. APPROACH: In February 2014, leaders at Johns Hopkins Medicine (JHM) implemented a governance, oversight, and accountability structure for quality and safety efforts across JHM ambulatory practices. This model was based on the fractal approach, which balances independence and interdependence and provides horizontal and vertical support. It set expectations of accountability at all levels from the Board of Trustees to frontline staff and featured a cascading structure that reached all units and ambulatory practices. This model leveraged an Ambulatory Quality Council led by a physician and nurse dyad to provide the infrastructure to share best practices, continuously improve, and define accountable local leaders. OUTCOMES: This model was incorporated into the quality and safety infrastructure across JHM. Improved outcomes in the domains of patient safety/risk reduction, externally reported quality measures, patient care/experience, and value have been demonstrated. An additional benefit was an improvement in Medicaid value-based purchasing metrics, which are linked to several million dollars of revenue. NEXT STEPS: As this model matures, it will serve as a mechanism to align quality standards and programs across regional, national, and international partners and to provide a clear quality structure as new practices join the health system. Future efforts will link this model to JHM’s academic mission, enhancing education to address Accreditation Council for Graduate Medical Education core competencies.",
author = "Kravet, {Steven J} and Jennifer Bailey and Renee Demski and Peter Pronovost",
year = "2016",
month = "1",
day = "27",
doi = "10.1097/ACM.0000000000001102",
language = "English (US)",
journal = "Academic Medicine",
issn = "1040-2446",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Establishing an Ambulatory Medicine Quality and Safety Oversight Structure

T2 - Leveraging the Fractal Model

AU - Kravet, Steven J

AU - Bailey, Jennifer

AU - Demski, Renee

AU - Pronovost, Peter

PY - 2016/1/27

Y1 - 2016/1/27

N2 - PROBLEM: Academic health systems face challenges in the governance and oversight of quality and safety efforts across their organizations. Ambulatory practices, which are growing in number, size, and complexity, face particular challenges in these areas. APPROACH: In February 2014, leaders at Johns Hopkins Medicine (JHM) implemented a governance, oversight, and accountability structure for quality and safety efforts across JHM ambulatory practices. This model was based on the fractal approach, which balances independence and interdependence and provides horizontal and vertical support. It set expectations of accountability at all levels from the Board of Trustees to frontline staff and featured a cascading structure that reached all units and ambulatory practices. This model leveraged an Ambulatory Quality Council led by a physician and nurse dyad to provide the infrastructure to share best practices, continuously improve, and define accountable local leaders. OUTCOMES: This model was incorporated into the quality and safety infrastructure across JHM. Improved outcomes in the domains of patient safety/risk reduction, externally reported quality measures, patient care/experience, and value have been demonstrated. An additional benefit was an improvement in Medicaid value-based purchasing metrics, which are linked to several million dollars of revenue. NEXT STEPS: As this model matures, it will serve as a mechanism to align quality standards and programs across regional, national, and international partners and to provide a clear quality structure as new practices join the health system. Future efforts will link this model to JHM’s academic mission, enhancing education to address Accreditation Council for Graduate Medical Education core competencies.

AB - PROBLEM: Academic health systems face challenges in the governance and oversight of quality and safety efforts across their organizations. Ambulatory practices, which are growing in number, size, and complexity, face particular challenges in these areas. APPROACH: In February 2014, leaders at Johns Hopkins Medicine (JHM) implemented a governance, oversight, and accountability structure for quality and safety efforts across JHM ambulatory practices. This model was based on the fractal approach, which balances independence and interdependence and provides horizontal and vertical support. It set expectations of accountability at all levels from the Board of Trustees to frontline staff and featured a cascading structure that reached all units and ambulatory practices. This model leveraged an Ambulatory Quality Council led by a physician and nurse dyad to provide the infrastructure to share best practices, continuously improve, and define accountable local leaders. OUTCOMES: This model was incorporated into the quality and safety infrastructure across JHM. Improved outcomes in the domains of patient safety/risk reduction, externally reported quality measures, patient care/experience, and value have been demonstrated. An additional benefit was an improvement in Medicaid value-based purchasing metrics, which are linked to several million dollars of revenue. NEXT STEPS: As this model matures, it will serve as a mechanism to align quality standards and programs across regional, national, and international partners and to provide a clear quality structure as new practices join the health system. Future efforts will link this model to JHM’s academic mission, enhancing education to address Accreditation Council for Graduate Medical Education core competencies.

UR - http://www.scopus.com/inward/record.url?scp=84955589086&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84955589086&partnerID=8YFLogxK

U2 - 10.1097/ACM.0000000000001102

DO - 10.1097/ACM.0000000000001102

M3 - Article

C2 - 26826071

AN - SCOPUS:84955589086

JO - Academic Medicine

JF - Academic Medicine

SN - 1040-2446

ER -