Healthcare improvement

The Institute for Healthcare Improvement (IHI) (IHI 2008) launched a national American campaign for improvement and five years after the IOM report Leape and Berwick summarise what has happened, analysed the reasons why improvement has not been greater, and made recommendations for what needs to be accomplished to realise the IOM s vision (Leape and Berwick 2005). After that IHI has launched a new campaign (5 Million lives) and added intervention targets as presented in Box 7.2(IHI 2008). The specific drug-related problems and interventions are market in bold and will be highlighted below. 

Leape LL, Kabcenell A, Berwick DM, et al. 1998b. The challenge. In Reducing Adverse Drug Events Breakthrough Series Guide, p. xiv. Boston Institute for Healthcare Improvement. 

Barry R, Murcko AC, Brubaker CE. The six sigma book for healthcare Improving outcomes by reducing errors. Chicago Health Administration Press 2002. 

BERWICK DM. "TAKING ACTION TO IMPROVE SAFETY HOW TO IMPROVE THE CHANCES OF SUCCESS." PRESENTATION AT THE ANNENBERG CENTER FOR HEALTH SCIENCES CONFERENCE, ENHANCING PATIENT SAFETY AND REDUCING ERRORS IN HEALTH CARE, IN RANCHO MIRAGE, CALIFORNIA. NOVEMBER 8-10, 1998. REPRODUCED WITH PERMISSION FROM INSTITUTE FOR HEALTHCARE IMPROVEMENT)... 

The Institute for Healthcare Improvement (IHI) has pioneered quality improvement in healthcare, drawing together ideas and practical experience from healthcare and many other sources. We will use their approach to reducing medication error as an overall framework to illustrate the potential of process improvement, addressing the particular role of technology in a later section. 

Adapted from Berwick DM. Taking Action to Improve Safely Howto Improvethe Chances of Success." Presentation at the Annenberg Center for Health Sciences conference. Enhancing Patient Safety and Reducing Errors in Heaith Care, in Rancho Mirage, California. November 8-10, 1998. Reproduced with permission from Institute for Healthcare Improvement.)... 

SOURCE INSTITUTE FOR HEALTHCARE IMPROVEMENT- IMPROVEMENT REPORT. SEDUCING ABBS PER 1,000 DOSES ORDER OF ST. FRANCIS — ST. JOSEPH MEDICAL CENTER (BLOOMINGTON ILLINOIS, USA). AVAILABLE AT http //www.ihi.org/IHI/Topics/PatientSafety/ MedicationSystems/IniprovementStories/ImprovementReportReducingADEsperlOOODoses.htm)... 

The Institute for Healthcare Improvement (IHI) chose six practices, which they had worked with in the past and which, for the most part, had a strong evidence base behind them ... 

There ate a number of methods that have been used for measuring safety performance in a specific organisation and its subsets or work units, such as departments and wards. Common methods such as observation, interviews and questionnaire surveys have not only been applied to achieve this, but special methods have also been developed. One of the special methods for this purpose is the Global Trigger Tool, which was developed by the Institute for Healthcare Improvement (Griffin and Resar 2009 IHI 2006). Some methods can make use of data that have been collected originally for other purposes and exploit the data to measure the safety performance of an organisation or its work units. A typical... 

Griffin, F. A. and Resar, R.K. 2009. IHI Global Trigger Toolfor Measuring Adverse Events (Second Edition). IHI Irmovation Series white paper. Cambridge, MA Institute for Healthcare Improvement. 

IHl 2006. IHI Global Trigger Tool Guide (Version 7). Cambridge, MA Institute for Healthcare Improvement. 

Barry, R., Murcko, A. C., Brubaker, C. E., The Six Sigma Book for Healthcare Improving Outcomes by Reducing Errors, Health Administration Press, Chicago, 2003. 

The implementation of a voluntary blameless reporting system is a deep cultural intervention in an organization that legitimizes transparency of system vulnerability, nurtures an alert field, and empowers front-line providers to expose risks. In turn, the front line learns to expect responses from managers at the blunt end to support the work of improvement. The few organizations in health care that have developed reporting systems believe that the effort is 75 percent social and only 25 percent technical (personal communication from Anne-Claire France, former director of the Center for Healthcare Improvement, Memorial Hermann Healthcare... 

The foUowing story is condensed from that told by Sorrel King, mother of Josie King, at the Institute of Healthcare Improvement conference on October 11, 2002 (King, 2003 see the Resources to access the full text of her speech) ... 

For example. Memorial Hermann used nine measures developed by the Institute for Healthcare Improvement as a starting point for reducing ventilator-acquired pneumonias (VAPs) and increasing safety and quality of care for ventilated patients. Individuals traveled to an IHI collaborative meeting and then returned to Memorial Hermann and passed on what they had learned to multidisciplinary teams from each of the hospital system s ICUs. 

Leape, L. L., Kabcenell, A., Berwick, D. M., and Roessner, J. IHIBreakthrough Series Guide Reducing Adverse Drug Events. Boston Institute for Healthcare Improvement, 1998. 

FAGGT Foundation for Accountability FDA (U.S.) Food and Drug Administration FMEA Failure Mode and Effects Analysis FIMPS Flarvard Medical Practice Study FIRO high-reliability organization IFII Institute for Healthcare Improvement lOM Institute of Medicine IPS intensive (care unit) physician staffing ISMP Institute for Safe Medication Practices JAMA Journal of the American Medical Association... 

National Coalition on Health Care and Institute for Healthcare Improvement. Reducing Medical Errors and Improving Patient Safety, [http //nchc.org/releases/medical errors.pdf] Washington, D.C. National Coalition on Health Care and Institute for Healthcare Improvement, 2001. 

This one-act play provides jarring examples from aviation of ways in which the performance of fragmented teams can lead to disaster. Stagings of this play have been used by the Institute for Healthcare Improvement and the National Patient Safety Foundation to illustrate the value of teamwork in high-stress situations. 

QualityHealthCare.org is a global knowledge environment created to help health care professionals accelerate their progress toward unprecedented levels of performance and improvement. The site is hosted by the Institute for Healthcare Improvement and the British Medical Journal. 

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