Field of Work: Quality improvement in hospitals
Problem Synopsis: In its 1999 report, To Err Is Human: Building a Safer Health System, the National Academy of Science's Institute of Medicine (IOM) reported that medical errors in hospitals killed between 44,000 and 98,000 people a year. The IOM's follow-up report, Crossing the Quality Chasm: A New Health System for the 21st Century, laid blame for most medical errors on the health care system, not providers, and called for a complete redesign of America's health care delivery system.
Synopsis of the Work: In 1999, Pittsburgh's philanthropic, business and health care leaders established the Pittsburgh Regional Healthcare Initiative (PRHI) to improve health care quality in Southwestern Pennsylvania. From 2000 to 2004, PRHI partnered with area hospitals in a project designed to improve quality of care and patient safety. From 2001 to 2003, researchers from the RAND Corporation conducted an evaluation comparing PRHI with regional coalitions working to improve health care quality in Cleveland, Minneapolis-St. Paul and Rochester, N.Y.
Key Results: PRHI reported the following quality improvements:
- Between 2001 and 2005, a total of 32 PRHI hospitals achieved a 68 percent reduction in bloodstream infections associated with central venous lines.
- The Veterans Health Administration Pittsburgh Healthcare System reported an 85 percent reduction in methicillin-resistant Staphylococcus aureus (MRSA) infections in the hospital's postsurgical units.
- As a consequence of an effort among partnering hospitals to increase the reporting of medical errors and to target reductions, the number of medication errors reported by partnering hospitals nearly doubled.
Key Evaluation Findings: In the report Regional Health Quality Improvement Coalitions: Lessons Across the Life Cycle, the evaluator listed a number of factors important for enabling PRHI and other regional coalitions to organize and progress toward their goals. Chief among these are: strong leadership; broad-based community commitment; availability of financial resources and incentives; adaptability and flexibility; dissemination of credible, objective and actionable data-driven information; and physician leadership in initiative development.