Virtual Quality Improvement Collaborative Improves Quality and Safety in Hospitals

    • July 31, 2012

Princeton, N.J.—The Robert Wood Johnson Foundation (RWJF) released results from a prestigious national program to improve the quality and safety of patient care in hospitals. The effort is part of Aligning Forces for Quality (AF4Q), the Foundation’s signature effort to improve the quality of health care in 16 targeted communities across the country, reduce disparities, and provide models of reform.

Ninety percent of the nearly 150 hospital teams participating in this AF4Q hospital quality improvement collaborative improved the quality of care for their patients in measurable ways, resulting in hundreds of avoided readmissions; improved patient safety; standardized data collection on patients’ race, ethnicity and language preference (R/E/L), a critical part of tracking and meeting diverse patient needs; and improved emergency department (ED) care.

Hospitals participating in the effort were part of a virtual network where they developed, shared, and implemented quality improvement tools, strategies, and lessons learned. The project was funded by RWJF and supported by experts at the George Washington University in Washington, D.C.

“We know that in every community across America, hospitals are delivering both good health care and bad health care,” said Susan Mende, BSN, MPH, senior program officer at the Robert Wood Johnson Foundation. “There are too many mistakes, too much miscommunication, and too much inequity in the care being delivered. Hospitals can do better, and the good news is that we have seen through Aligning Forces for Quality that hospitals are willing to really take stock of what they are doing well and where they could improve, and then take necessary steps needed to deliver the best care possible to their patients.”

Hospitals in the AF4Q collaborative spearheaded initiatives to help tackle key issues including collecting and tracking R/E/L data; improving language services for patients with limited English proficiency (LEP); limiting the time patients spend in EDs, and reducing hospital readmissions for patients recently discharged with a diagnosis of heart failure, as well as increasing adherence to care standards for those patients. Key results include:

Reducing hospital readmissions and increasing adherence to care standards,
National data show about one in four Medicare patients admitted to the hospital for chronic diseases return to the hospital within 30 days of being discharged. Hospitals participating in AF4Q worked to ensure that processes were followed and patients had all the information they needed to safely transition from the hospital setting. Results include:

  • Sixty percent of participating hospitals improved their 30-day readmission rates for heart failure patients. Combined, teams that reduced their readmissions rate avoided approximately 486 readmissions.
  • Seventy-five percent of the hospitals improved their adherence to heart failure care standards.

Improving language services for patients who speak or understand a language other than English,
All hospitals in the United States that accept government funds are required to provide interpreter services to patients who speak a language other than English, but there has been little guidance to hospitals on the most effective, efficient ways to implement these requirements. Research shows that communication, in a language the patient can understand, is fundamental for receiving and providing safe, high-quality health care. Hospitals participating in AF4Q worked to improve the efficiency of language services. Results include:

  • Through AF4Q, 1.5 million patients were screened for preferred spoken language, more than half a million were screened for preferred written language, and more than 4,500 patients had qualified interpreters at both initial assessment and discharge.
  • Ninety-five percent of participating hospital teams improved their screening rates to determine a patient’s preferred spoken language for health care.

Reducing emergency department crowding,
Crowding and poor patient flow impact quality and safety and cause patients to remain in the ED longer than necessary. Delays in care also cause some patients to leave the ED before being seen by a provider. Local hospitals participating in AF4Q worked systematically to improve ED efficiency. Results include:

  • As a result of hospitals’ efforts through AF4Q, 10,000 patients avoided leaving EDs before care was provided.
  • Fifty-five percent of participating teams reduced the time patients spent in their EDs by an average of 30 minutes.

Ensuring equity of care for all patients,
Collecting information on a patient’s R/E/L preferences enables hospitals to examine their processes to ensure that equitable care is provided to all patients. Hospitals participating in AF4Q made consistent collection of this information a top priority. Results include:

  • During the collaborative, nearly 95 percent of participating teams standardized the way they collect patient self-reported R/E/L data.
  • As a result of the work of this initiative, these hospitals now have race, ethnicity, and language data for all of their patients. These data are a powerful analytic tool that gives these hospitals the ability to look for disparities within any subgroup or any condition.

"Sharing ideas while improving the quality of care for patients motivated individuals and gave them a new energy which resulted in better teamwork, culture change, and system transformation. This is a good start, but implementing these strategies is just the beginning of the story," said Robert Graham, MD, director of Aligning Forces for Quality. “We hope these hospitals and teams will continue to test and evaluate their results, making adjustments wherever needed to build upon the gains from this unique initiative and to ensure on-going progress and sustainability of this important work."



About the Robert Wood Johnson Foundation

The Robert Wood Johnson Foundation focuses on the pressing health and health care issues facing our country. As the nation’s largest philanthropy devoted exclusively to health and health care, the Foundation works with a diverse group of organizations and individuals to identify solutions and achieve comprehensive, measurable, and timely change. For 40 years the Foundation has brought experience, commitment, and a rigorous, balanced approach to the problems that affect the health and health care of those it serves. When it comes to helping Americans lead healthier lives and get the care they need, the Foundation expects to make a difference in your lifetime. Follow the Foundation on Twitter ( or Facebook (

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Robert Wood Johnson Foundation (609) 627-5937