The Quality ‘Journey’ At Ascension Health: How We’ve Prevented At Least 1,500 Avoidable Deaths A Year—And Aim To Do Even Better

Abstract

A decade ago the Institute of Medicine estimated that 44,000-98,000 preventable deaths occur each year in US hospitals. The leaders of Ascension Health-one of the nation's largest health care delivery networks, with sixty-nine hospitals in twenty states and the District of Columbia-dedicated themselves to preventing equivalent numbers of deaths in their system. In 2003 they set a goal of reducing preventable deaths by 900 each year by 2008. By fiscal year 2010 Ascension Health had reduced preventable deaths by more than 1,500 people annually and, by some calculations, by more than 5,000 people annually, compared to 2004. Ascension Health had also achieved important improvements in preventing birth trauma and reducing rates of pressure ulcers and hospital-acquired infections. The health care system could achieve even greater results by adopting the safety principles used in high-reliability entities such as the nuclear power industry. The adoption of such principles can lead to impressive improvements in health care quality.

Management Practices and the Quality of Care in Cardiac Units

“…Our findings are consistent with the empirical research in manufacturing and reports of individual organizational successes that have been attributed to the adoption of Lean management and related approaches. 21,[43][44][45][46][47] Our findings parallel additional studies of management in health care settings. A survey of 537 hospitals identified 5 key strategies that were significantly associated with lower AMI mortality and noted that a small proportion of hospitals used all 5 strategies.…”

More quality measures versus measuring what matters: a call for balance and parsimony

“…The most productive improvement in quality for a specific organisation depends upon where they are in their quality journey (eg, going from 10 À1 to 10 À2 harm events needs different approaches than going from 10 À3 to 10 À4 harm events). 9 It may be better policy to have a small required set of quality metrics and large optional sets so that organisations can target their improvements on areas where they are most needed. Third, some providers appear to have made sham improvements (eg, distributing a smoking cessation leaflet to all heart failure patients at midnight to ensure 100% compliance with a particular core metric) that meet the measurement requirement but not the patient need for a meaningful intervention.…”

Addressing the Critical Role of Nurse Leaders in Advancing Quality and Safety

“…In addition, the other indicators showing improvement rely on nursing leadership and involvement. 8 These are but two examples of the measurable impact that nurses and nurse leaders have on quality and patient safety.…”