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A project based learning module aimed at patient safety from an allied healthcare perspective.

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Help

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A fun and interactive course designed to help you explore the edX learning experience. Perfect to take before you start your course.

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Havrard University Course

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To help you with your improvement efforts, IHI offers free tools, change ideas, measures to guide improvement, IHI White Papers, audio and video, improvement stories, and more.

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Resources

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Quality Safety Resources

AONE has identified the following resources on quality and safety to assist you in preventing and analyzing health care-related adverse events and close calls. Additional tools can be found here.
To ensure you are viewing the most up-to-date information on any of the web-based resources, you may want to start at the home page and then progress to the pages with quality and safety content.
Please report any broken links and forward suggestions for additional resources to Janet Stifter. Commercial web sites and products other than patient safety books and publications will not be considered for inclusion.

Resource links

National Organizations

National Quality Forum (NQF)
The National Quality Forum (NQF) is a not-for-profit, nonpartisan, membership-based organization that works to catalyze improvements in healthcare. The NQF convenes working groups to foster quality improvement in both public- and private-sectors; endorses consensus standards for performance measurement; ensures that consistent, high-quality performance information is publicly available; and seeks real time feedback to ensure measures are meaningful and accurate.

National Association for Healthcare Quality (NAHQ)
The National Association for Healthcare Quality (NAHQ) is a professional association dedicated to the advancement of the profession of healthcare quality and patient safety and the individual professionals working in the field. Founded in 1976, NAHQ has more than 10,000 quality and patient safety professionals working in healthcare settings both nationally and internationally. These professionals drive the delivery of vital data for effective decision making in healthcare systems by combining technology with their unique expertise in quality management. The purpose of the NAHQ is to improve healthcare quality across all points of care through education, certification, and advocacy through identifying and creating a core body of knowledge to advance healthcare quality and patient safety; identifying and promoting professional competencies and practices necessary to effectively apply the knowledge; raising public awareness and fostering communications about healthcare quality and patient safety; and fostering collaboration with like-purposed professionals to advance mutual goals and improve NAHQ's ability to meet its goals.

Institute for Healthcare Improvement (IHI)
The Institute for Healthcare Improvement (IHI), an independent not-for-profit organization, is a leading innovator, convener, partner, and driver of results in health and health care improvement worldwide. IHI's work is focused in five key areas: improvement capability; person- and family-centered care; patient safety; quality, cost, and value; and triple aim for populations.

The Joint Commission on the Accreditation of Healthcare Organizations
An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 20,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization's commitment to meeting certain performance standards. The mission of The Joint Commission is to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value.

The Leapfrog Group
The Leapfrog Group is an initiative driven by organizations that buy health care who are working to initiate breakthrough improvements in the safety, quality and affordability of healthcare for Americans. Leapfrog is a member supported program aimed at mobilizing employer purchasing power to alert America's health industry that big leaps in health care safety, quality and customer value will be recognized and rewarded.

Patient-Centered Outcomes Research Institute (PCORI)
The Patient-Centered Outcomes Research Institute (PCORI) is authorized by Congress to conduct research to provide information about the best available evidence to help patients and their health care providers make more informed decisions. PCORI's research is intended to give patients a better understanding of the prevention, treatment and care options available, and the science that supports those options.

AcademyHealth
AcademyHealth seeks to improve health and health care by generating new knowledge and moving knowledge into action.

Robert Wood Johnson Foundation (RWJF)
The Robert Wood Johnson Foundation (RWJF) is the United States' largest philanthropy focused solely on the public's health. RWJF is committed to identifying and supporting evidence-based, measurable, and equitable initiatives.

Federal (U.S.) Organizations

Agency for Healthcare Research and Quality (AHRQ)
AHRQ's mission is to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable, and to work with the U.S. Department of Health and Human Services (HHS) and other partners to make sure that the evidence is understood and used. AHRQ's priority areas of focus are to improve health care quality by accelerating implementation of patient-centered outcomes research; make health care safer; increase accessibility to health care; and improve health care affordability, efficiency, and cost transparency. View the AHRQ Quality and Patient Safety page.

Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services (CMS) is an agency within the US Department of Health & Human Services responsible for administration of several key federal health care programs. In addition to Medicare (the federal health insurance program for seniors) and Medicaid (the federal needs-based program), CMS oversees the Children's Health Insurance Program (CHIP), the Health Insurance Portability and Accountability Act (HIPAA) and the Clinical Laboratory Improvement Amendments (CLIA), among other services.

Advocacy Groups

National Patient Safety Foundation (NPSF)
The National Patient Safety Foundation's vision is to create a world where patients and those who care for them are free from harm. A central voice for patient safety since 1997, NPSF partners with patients and families, the health care community, and key stakeholders to advance patient safety and health care workforce safety and disseminate strategies to prevent harm. NPSF is an independent, not-for-profit 501(c)(3) organization.

AHA Affiliates

American Society for Healthcare Risk Management (ASHRM)
Established in 1980, the American Society for Healthcare Risk Management (ASHRM) is a personal membership group of the American Hospital Association (AHA) with nearly 6,000 members representing risk management, patient safety, insurance, law, finance and other related professions. ASHRM promotes effective and innovative risk management strategies and professional leadership through education, recognition, advocacy, publications, networking and interactions with leading healthcare organizations and government agencies. ASHRM initiatives focus on developing and implementing safe and effective patient care practices, the preservation of financial resources and the maintenance of safe working environments.

Health Research and Education Trust (HRET)
Founded in 1944, the Health Research & Educational Trust (HRET) is the not-for-profit research and education affiliate of the American Hospital Association (AHA). HRET's mission is to transform health care through research and education. HRET's applied research seeks to create new knowledge, tools and assistance in improving the delivery of health care by providers and practitioners within the communities they serve.

Hospitals in Pursuit of Excellence (HPOE)
Hospitals in Pursuit of Excellence (HPOE) is the American Hospital Association's strategic platform to accelerate performance improvement and support delivery system transformation in the nation's hospitals and health systems. HPOE provides education on best practices through multiple channels, develops evidence-based tools and guides, provides leadership development through fellowships and networks, and engages hospitals in national improvement projects. Working in collaboration with allied hospital associations and national partners, HPOE synthesizes and disseminates knowledge, shares proven practices and spreads innovation to support care improvement at the local level.

Quality Certification

Certified Professional in Healthcare Quality (CPHQ)
The CPHQ credential signifies professional and academic achievement by individuals in the field of healthcare quality management

Safety Certification

Certification Board for Professionals in Patient Safety (CBPPS)
The Certification Board for Professionals in Patient Safety (CBPPS) was formed to oversee a rigorous and comprehensive credentialing process that attests to patient safety competencies and expertise. The board's chief responsibility is the development and administration of an evidence-based examination that provides candidates with a process by which they can demonstrate their competency in patient safety science and application

Johns Hopkins Medicine Armstrong Institute for Patient Safety and Quality
This five-day program covers such essential topics as patient safety culture, patient-centered care, safe design principles, and interdisciplinary teamwork and communication. With these foundational principles as background, participants will explore how to identify and mitigate risks and develop data-driven change efforts, using human factors engineering and Lean strategies to guide their improvement plans. They will see how the Comprehensive Unit-Based Safety Program (CUSP) provides one model for achieving patient safety outcomes.

American Society for Healthcare Risk Management (ASHRM) Patient Safety Certificate Program
ASHRM has designed a unique two-part Patient Safety curriculum to help healthcare risk management and patient safety professionals understand and apply their key contributions to improved patient care and outcomes. Participants will review the foundational concepts of patient safety and learn to effectively apply them to effect positive change in their organization.

Patient Experience

Cleveland Clinic Office of Patient Experience
Cleveland Clinic was the first major academic medical center to make patient experience a strategic goal, the first to appoint a Chief Experience Officer, and one of the first academic medical centers to establish an Office of Patient Experience. The Office of Patient Experience's mission is to ensure consistently patient-centered care by partnering with caregivers to exceed the expectations of patients and families. The Office serves as an advisory resource for critical initiatives across the Cleveland Clinic health system; provides resources and data analytics; identifies, supports, and publishes sustainable best practices; and collaborates with a variety of departments to ensure the consistent delivery of patient-centered care.

Association for Patient Experience
The Association for Patient Experience is a 501(c)(3) organization established to support healthcare professionals, patients, and their families by improving the patient experience. The Association for Patient Experience seeks greater understanding of key drivers contributing to positive patient experiences, strives to develop and share creative, sound solutions to common patient experience issues, continually anticipates the future of healthcare delivery and drives innovative changes in the patient experience, and advocates on behalf of patients and families and is not intimidated by the complexity of improving the healthcare experience.

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AONE has identified the following resources on quality and safety to assist you in preventing and analyzing health care-related adverse events and close calls.

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The Josie King Story

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Short clip of Josie King Story for QSEN website

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U S Food and Drug Administration Home Page

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Home Page for the Food and Drug Administration (FDA)

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Hospital Accreditation | Joint Commission

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Agency for Healthcare Research & Quality

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Agency for Healthcare Research and Quality 5600 Fishers Lane Rockville, MD 20857Telephone: (301) 427-1364

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Clinical Practice Guidelines

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American Association for Respiratory Care - AARC

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American Association for Respiratory Care (AARC) is an association for respiratory care and allied health professionals interested in cardiopulmonary care.

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Document Library

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by IHI

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Quality and Patient Safety | Agency for Healthcare Research & Quality

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As part of its goal to support a culture of patient safety and quality improvement in the Nation's health care system, the Agency for Healthcare Research and Quality (AHRQ) sponsored the development of patient safety culture assessment tools for hospitals, nursing homes, ambulatory outpatient medical offices, community pharmacies, and ambulatory surgery centers.

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Quality Homepage

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Forming a Quality Improvement Team at a Practice

Improvement work invariably involves work across multiple systems and disciplines within a practice. The quality improvement (QI) team or committee (QIC) is the group of individuals within a practice charged with carrying out improvement efforts. The team may report to the organization's chief executive officer. To be effective, the team should include individuals representing all areas of the practice that will be affected by the proposed improvement, as well as patient representatives.

The QI team meets regularly to review performance data, identify areas in need of improvement, and carry out and monitor improvement efforts. For these activities, the teams will use a variety of QI approaches and tools, including the Model for Improvement (MFI), Plan Do Study Act (PDSA) cycles, workflow mapping, assessments, audit and feedback, benchmarking, and best practices research.

The team should have a clearly identified "champion" who is committed to the ideal and process of continuous improvement. This individual should be interested in building capacity in the practice for ongoing improvement and implementing effective "processes" that will enable improvement. Such processes may include gathering and reflecting on data, seeking out best practices, and engaging voices and perspectives of individuals involved in all aspects of the process/activity under scrutiny. The role of the QI team champion is to ensure that the team functions effectively and fulfills its charter for the organization.

Who Should Be on a Quality Improvement Team?

The Institute for Healthcare Improvement (IHI) recommends that every team include at least one member who has the following roles:

Clinical leadership. This individual has the authority to test and implement a change and to problem solve issues that arise in this process. This individual understands how the changes will affect the clinical care process and the impact these changes may have on other parts of the organization.

Technical expertise. This individual has deep knowledge of the process or area in question. A team may need several forms of technical expertise, including technical expertise in QI processes, health information technology systems needed to support the proposed change, and specifics of the area of care affected. For example, a team implementing an intensive care management clinic for people with poorly controlled diabetes might need technical expertise in change management, the clinic's electronic health record, and the patient treatment protocols that will be used.

Day-to-day leadership. This individual is the lead for the QI team and ensures completion of the team's tasks, such as data collection, analysis, and change implementation. This person must work well and closely with the other members of the team and understand the full impact of the team's activities on other parts of the organization as well as the area they are targeting.

Project sponsorship. This individual has executive authority and serves as the link to the QI team and the organization's senior management. Although this individual does not participate on a daily basis with the team, he or she may join periodically and stays apprised of its progress. When needed, this member can assist the team in obtaining resources and overcoming barriers encountered when implementing improvements.

The optimal size of a QI team is between five and eight individuals, although this may vary by practice. The most important requirement is not size, but diversity of the participants. It is important that the team include a diverse group of individuals who have different roles and perspectives on the patient care or other processes under consideration. This group should include whenever possible input from the "end user" of health care, the patient.

Potential members of a QI team might be:

Chief executive officer.

Medical directors.

Physicians.

Nursing staff.

Physician assistants.

Medical assistants.

Patient representatives.

Operations manager/director.

Health educators.

Community health workers.

Peer mentors.

Patients.

Community representatives.

Directors of clinical services.

Practice managers.

Medical records staff.

Receptionists.

Lab technicians.

Pharmacy or dispensary staff.

Case managers.

Physical plant operations.

Billing department staff.

Finance director.

i Adapted from the Institute for Healthcare Improvement. Science of Improvement: Forming the Team. Available at: http://www.ihi.org/knowledge/Pages/HowtoImprove/ScienceofImprovementFormingtheTeam.aspx.

Creating a Quality Improvement Plan With a Practice

One of the first tasks to complete with the QI team is to identify goals for the improvement work and associated performance metrics. It is useful to have preliminary performance data available to use in setting improvement goals whenever possible. Goals are fluid and will likely change during your work with the practice as more information is gathered on practice performance and functioning and as the team achieves preliminary goals and is ready to move on to new ones.

Using Key Driver Models To Focus Quality Improvement Plans

Key driver models are roadmaps to particular outcomes that help focus the work of a facilitation program, as well as the work of individual facilitators and facilitation teams at the practice level. Key drivers define the pathway to a desired transformation. Key driver models graphically display the strategies and activities needed to achieve goals and aims of the practice improvement effort ( DeWalt, et al., 2010).

Facilitation programs typically use two levels of key driver models:

One at the programmatic level that outlines the facilitation program's overarching goals and underlying model for change, and

One at the practice level, which tailors the programmatic model to the needs and priorities of individual practices.

Program-level and practice-level key driver models include:

Desired outcomes for the practice improvement effort,

Big changes or "key drivers" that are most likely to accomplish these goals, and

Specific changes or action items that must occur to produce the desired big changes.

Example of a Key Driver Model

Figure 14.1 shows a program-level key driver model for improving diabetic and asthmatic patient outcomes based on the Care Model (see Module 16). This key driver model was developed for the Improving Performance in Practice Initiative funded by the Robert Wood Johnson Foundation and provided by Dr. Darren DeWalt.

The far left column shows specific QI goals. The middle column contains the organizational and care processes thought to improve care and patient outcomes. These key drivers function as a menu from which practices can choose the approaches they will use to achieve their goals. The far right column contains the "change concepts" or action items/steps to implement a particular key driver.

Designing a Key Driver Model With a Practice

You should work with the practice to develop a practice-level key driver model that links to the outcomes identified by the practice and targeted by the facilitation intervention. The practice's QI plan should be based on the practice-level key driver model to reflect the change concepts included in the model. If your program has a predefined key driver model for the intervention, you should review the prescribed model with the practice's QI team and work with them to identify the drivers and change concepts they want to implement first, second, and third. You should also ask the practice to identify what other items not currently represented on the key driver model they are interested in changing, and make these additions accordingly.

If your facilitation program does not have a key driver model for the change work the practice wants to do, consult the guide Developing and Running a Primary Care Practice Facilitation Program ( Knox, et al., 2011). You will find guidance on creating a key driver model, including a couple of samples showing different forms key driver models can take.

A first step in developing a key driver model is to choose goals that are clearly defined. Goals and outcomes should be SMART:

When defining its change goals, the practice should include numeric targets. Distinguish between goals that will be accomplished during the period you are facilitating (if it's time limited) and longer term goals. They should be based on the results of the practice assessment and focus on the areas needing improvement.

As you work with the practice on developing its practice-level key driver model, point out materials and resources to support the improvement activities and tasks associated with each key driver. For example, the Integrating Chronic Care and Business Strategies in the Safety Net Toolkit ( AHRQ, 2008) contains many tools useful to practices implementing the Care Model. You will need to familiarize yourself with resources that you can use to support these changes in the practice.

As part of developing this plan, you will also need to help the practice establish an inventory of the resources, assets, and personnel talents that currently exist in their practice and can be leveraged to support Care Model implementation and its associated key drivers and change concepts.

Creating a Quality Improvement Plan

A QI plan should provide guidance to the practice on who is to participate on the QI team, how often it is to meet, and what its goals and key activities are. In addition, the plan should lay out the process that will be used to drive improvement in the practice, such as the MFI and PDSA cycles, how these are to be documented, and the way current and ongoing status is going to be monitored using data. A good QI plan includes among other things:

A statement of the quality vision.

A description of the program structure.

A membership for the QI team or committee that is diverse.

A meeting schedule.

A defined process for how QI will be conducted.

A list of improvement goals or priorities that are specific, measurable, achievable, relevant, and time bound.

A plan for how both the plan and the goals will be evaluated.

A plan for how performance data will be acquired and reported.

An important role you can play as a practice facilitator will be to assist practices in developing a plan or to review the plan they already have.

Monitoring Progress on the Quality Improvement Plan

With new QI teams, another role you can play is to help the team develop systems that will allow them to track progress toward their improvement goals and monitor their performance on key quality indicators. To do this, you will need to work with practice leadership and staff to set up data systems that can produce practice performance reports on key quality metrics on a monthly or quarterly basis. As much as possible, you should assist the practice to automate the development of these reports so that the burden on staff is minimized or to design the data collection process so staff can carry it out in addition to their existing duties. An elegant system that cannot be sustained is no better than having no system at all.

You will need to work with the QI team to develop a standard template for the performance report and identify the time period for reporting. You will also need to assist them in identifying the staff needed to prepare the reports and the time they will need to accomplish this task. In addition, you will need to work with the team to revise staff job descriptions to include this task, as well as their performance evaluation. You will also need to help them train staff on these tasks.

A QI dashboard or data wall can be a useful tool for QI teams to help them track progress toward key improvement goals. QI dashboards or data walls are one- to three-page summary reports that provide a graphic summary of progress toward key process and outcome metrics. Often they include a "stoplight" system of red, yellow, and green color coding to signal that an activity or performance metric is on track, partially off track, or having serious problems. It can be helpful to include a dashboard of progress toward the elements of the key driver model if one was included as part of the QI plan. In addition, it can be useful to include copies of any PDSA cycles that are underway or completed with the dashboard to enable the QI team to easily review its progress.

The report will create a written record of the team's progress and help increase ownership and accountability in the QI team and practice for follow-through on improvement work. It also can help you identify QI teams that have hit a roadblock and may need some additional assistance from an expert consultant or a facilitator with a different set of skills. You can add this expertise to your facilitation team if it is needed.

References

DeWalt D, Powell J, Mainwaring B, et al. Practice coaching program manual. Princeton, NJ: Aligning Forces for Quality (AF4Q), George Washington University Medical Center; 2010.

Integrating chronic care and business strategies in the safety net. (Prepared by Group Health's MacColl Center for Health Care Innovation, in partnership with RAND and the California Health Care Safety Net Institute, under Contract No./Assignment No: HHSA2902006000171). AHRQ Publication No. 08-0104-EF. Rockville, MD: Agency for Healthcare Research and Quality; September 2008.

Knox L, Taylor EF, Geonnotti K, et al. Developing and running a primary care practice facilitation program: a how-to guide (Prepared by Mathematica Policy Research under Contract No. HHSA290200900019I TO5.) Rockville, MD: Agency for Healthcare Research and Quality; December 2011. AHRQ Publication No. 12-0011. Available at: http://pcmh.ahrq.gov/portal/server.pt/community/pcmh__home/1483/pcmh_implementing_the_pcmh___practice_facilitation_v2. Accessed April 4, 2013.

SMART Objectives. The Smart Bites Toolkit. Institute of Medicine. Available at: http://www.iom.edu/About-IOM/Making-a-Difference/Community-Outreach/~/media/Files/About%20the%20IOM/SmartBites/Planning/P1%20SMART%20Objectives.ashx. Accessed April 26, 2013.

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Module 14. Creating Quality Improvement Teams and QI Plans | Agency for Healthcare Research & Quality

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Improvement work invariably involves work across multiple systems and disciplines within a practice. The quality improvement (QI) team or committee (QIC) is the group of individuals within a practice charged with carrying out improvement efforts. The team may report to the organization's chief executive officer.

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How do I implement a quality improvement process for my problem and goal?

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What are the industry standards and best practices realated to patient safety and quality? Are my institution policies and procedures aligned with these best practices?

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After presenting to a rural emergency department with chest pain, a man with a history of diabetes awaited admission to the hospital. The off-site admitting internist ordered aspirin and a heparin drip, but neither medication was administered. On transfer to the acute care unit 2 hours later, the patient was diaphoretic, somnolent, tachycardic, and borderline hypotensive.

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The Institute for Healthcare Improvement

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health care quality improvement training

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Improving Health and Health Care Worldwide | IHI - Institute for Healthcare Improvement

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Institute for Healthcare Improvement (IHI) focuses on improvement science and patient safety to advance and sustain better outcomes in health and health care across the world.

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National Patient Safety Goals® | Joint Commission

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What are the safety issues and goals set by the agencies that govern healthcare quality and safety? How can they be applied to your practice?

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2. RESEARCH the History of Safety in Healthcare

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2. RESEARCH the History of Safety in Healthcare

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Where we've been and where we are going?

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What we are doing about it

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"The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been."
Donald M. Berwick, MD, MPP, President Emeritus, Institute for Healthcare Improvement

Excerpted from Dr. Berwick's plenary address at IHI's 16th Annual National Forum on Quality Improvement in Health Care (December 2004)
[*Reprinted in: Berwick DM. Promising Care: How We Can Rescue Health Care by Improving It. "Chapter 2: Some Is Not a Number, Soon Is Not a Time." San Francisco: Jossey-Bass; 2014.]

What was the 5 Million Lives Campaign?

The aim of the 5 Million Lives Campaign was to support the improvement of medical care in the US, significantly reducing levels of morbidity (illness or medical harm such as adverse drug events or surgical complications) and mortality. IHI quantified this aim and set a numeric goal: we asked hospitals participating in the Campaign to prevent 5 million incidents of medical harm over a period of two years (December 12, 2006 through December 9, 2008).

IHI and its partners in the Campaign encouraged hospitals and other health care providers to take the following steps to reduce harm and deaths:

Prevent Pressure Ulcers by reliably using science-based guidelines for prevention of this serious and common complication

Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infection through basic changes in infection control processes throughout the hospital

Prevent Harm from High-Alert Medications starting with a focus on anticoagulants, sedatives, narcotics, and insulin

Reduce Surgical Complications by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)

Deliver Reliable, Evidence-Based Care for Congestive Heart Failure to reduce readmission

Get Boards on Board by defining and spreading new and leveraged processes for hospitals Boards of Directors, so that they can become far more effective in accelerating the improvement of care

The Campaign also continued to offer support to hospitals as they introduced and sustained their work on interventions from the 100,000 Lives Campaign:

Deploy Rapid Response Teams at the first sign of patient decline

Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction to prevent deaths from heart attack

Prevent Adverse Drug Events (ADEs) by implementing medication reconciliation

Prevent Central Line Infections by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle"

Prevent Surgical Site Infections by reliably delivering the correct perioperative antibiotics at the proper time

Prevent Ventilator-Associated Pneumonia by implementing a series of interdependent, scientifically grounded steps including the "Ventilator Bundle"

What was measured in the 5 Million Lives Campaign?

At the Campaign level, we measured two things:

The number of acute care inpatient deaths that we would expect to occur in the Campaign period (2007 and 2008) given 2006 levels of care, but did not, because of improvements in care ("Lives Saved")

The number of incidents of medical harm that we would expect to occur in the Campaign period (2007 and 2008) given 2006 levels of care, but did not, because of improvements in care ("Harm Avoided")

We collected "lives saved" data through direct submission of acute care inpatient mortality data from participating hospitals. We collected data on "harm avoided" by conducting retrospective chart review in a representative sample of participating facilities.

What were the data submission requirements for the Campaign?

The data submission requirements for the 5 Million Lives Campaign were essentially the same as those for the 100,000 Lives Campaign. There were two components of required data submission:

Acute Care Inpatient Mortality data (deaths and discharges)

Submission and periodic update of a "Hospital Profile," a questionnaire that describes basic administrative and demographic characteristics of your hospital

This list of organizations fully committed to the 5 Million Lives Campaign by submitting full profile information and mortality data at least through the period of January 2006 through August 2008.

Hospitals are encouraged to continue making the improvements promoted during the 5 Million Lives Campaign and 100,000 Lives Campaign and are welcome to continue using the Campaign Extranet, but no longer need to submit their data to IHI.

What were some of the key events during the 5 Million Lives Campaign?

During the 5 Million Lives Campaign, a number of events were held to help support and celebrate the efforts of Campaign participants, including:

National Action Day: On June 20, 2007, over 35,000 participants joined a virtual meeting for Campaign participants to focus their attention on getting results faster and more reliably.

Fall Harvest: From October 25 through November 7, 2007, the Campaign celebrated the improvement work of over 3,600 hospitals by "harvesting" the ideas, innovations, and best practices they are using to improve care and reduce harm. The centerpiece of the Fall Harvest was a series of visits by the 5 Million Lives Campaign team, IHI faculty, and staff to hospitals in all 50 states and the District of Columbia. By meeting face to face with frontline improvers, we tapped the energy and ingenuity that was dramatically transforming patient care to share these discoveries with the entire Campaign community.

National Network Day: On October 27, 2008, the Campaign showcased some of the best and most innovative quality improvement and patient safety work happening in the US.

What did the 5 Million Lives Campaign accomplish?

Participants in the 5 Million Lives Campaign made exciting progress since the launch of the 100,000 Lives Campaign in December 2004. Hospitals across the US made unprecedented commitments to quality and patient safety, with many demonstrating impressive results. At its formal close in December 2008, the Campaign celebrated the enrollment of 4,050 hospitals, with more than 2,000 facilities pursuing each of the Campaign's 12 interventions to reduce infection, surgical complication, medication errors, and other forms of unreliable care in facilities. Eight states enrolled 100% of their hospitals in the Campaign, and 18 states enrolled over 90% of their hospitals in the Campaign.

A field office ("Node") managed local improvement activity in every state, and the Campaign identified 200 hospitals as mentors - teachers of peer facilities on all 12 of the Campaign's interventions. Every day we witnessed great innovation and activity in the field - there were thirty events around the country in April of 2008 alone.

Above all, we also witnessed striking signs of progress in improving patient outcomes. For example, 65 hospitals reported going a year or more without a ventilator-associated pneumonia, and 35 reported going a year or more without a central line-associated bloodstream infection in at least one of their ICUs. States have also accomplished a great deal; Rhode Island hospitals active in the Campaign reported a 42% decrease in central-line associated bloodstream infections from 2006 to 2007, and New Jersey saw a 70% reduction in pressure ulcers through the work of 150 organizations across the state.

Did hospitals in the Campaign prevent five million instances of harm?

The short answer to this question is that we don't know yet but IHI is working to better measure progress against its primary aim - massive reduction of patient injuries - through several mechanisms.

First and foremost, IHI completed a state-level harm study to assess patient injuries in a geographic area, North Carolina. IHI sponsored the independent pilot study with the hope that it could serve as a proof of concept for a national study. Researchers focused on validating the methodology for detecting and trending harm over time within an organization, and sought to establish a protocol by which national rates of harm could be measured reliably and accurately.

This study - the North Carolina Patient Safety Study - used the IHI Global Trigger Tool to review a random sample of medical records over a six-year period in a random sample of hospitals in that state. Preliminary indications are that the Global Trigger Tool is a valid, reliable methodology for harm detection in individual hospitals and can be used to track rates of harm over time. The study suggests that a similar approach could be used to measure harm rates nationally.

The study was not powered to detect small changes in the rate of harm over time, but further analyses are ongoing to understand the trends that were observed. The study protocol was developed by two prominent independent health services researchers who work in the patient safety field: Chris Landrigan, MD, MPH (Principal Investigator), and Paul Sharek, MD, MPH (Co-Principal Investigator). Additional input was provided by a distinguished independent Scientific Advisory Group. To ensure objectivity and scientific rigor, an independent Clinical Research Organization - Battelle Inc. - conducted the study. IHI's hope is that a national health care organization will conduct a national harm study using our pilot results and methodology as a guide, and that this national harm study will not just be a one-time assessment, but rather a continuous measurement project that will provide the country with a reliable metric of progress in this crucial area.

I'm interested in launching a large-scale change initiative like the Campaigns. What resources might help me?

Selected Publications about the IHI Campaigns

The 100,000 and 5 Million Lives Campaigns also helped to inspire other nationwide patient safety and quality improvement efforts around the world. You may also find it useful to learn about some of them:

US: 100,000 Homes
Brazil: Instituto Qualisa de Gestão
Canada: Safer Healthcare Now!
Denmark: Operation Life
Scotland: Patient Safety Alliance
Wales: 1,000 Lives Campaign

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The aim of the 5 Million Lives Campaign was to support the improvement of medical care in the US, significantly reducing levels of morbidity (illness or medical harm such as adverse drug events or surgical complications) and mortality.

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