J Clin Outcomes Manage
Large-scale system change improves outcomes; the pursuing perfection program
Nolan TW, Kabcenell A, Stevens JP, Martin LA
Abstract Objective: To describe interim results of a demonstration program aimed at achieving unprecedented improvements in health care outcomes and to discuss the implications for other ambitious, organization-wide improvement efforts. Methods: National demonstration project funded by the Robert Wood Johnson Foundation. With technical assistance provided by the Institute for Healthcare Improvement, 13 health care organizations committed to organization-wide improvement of all major care processes in specific care processes while enhancing infrastructure supporting these and future improvement efforts. Results: The first efforts to yield results addressed hospital deaths from acute myocardial infarction and harm to patients from adverse drug events. Three organizations concentrated on both of these areas. Each was able to reduce acute myocardial infarction mortality to 5% (below the lowest-decile benchmark of 7%) and to reduce adverse drug events to less than 1 per 1000 doses. Conclusion: Three years into the program, 3 participating organizations have achieved substantial results by setting ambitious aims: focusing on system-wide relationships and resources, developing infrastructure and processes that reliably deliver care based on the latest scientific evidence, and keeping patient and family concerns at the forefront of their efforts. Moreover, they now have the assets and skills to tackle further challenges that most have viewed as intractable.
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