Institute for Healthcare Improvement: Innovation Community: Designing for Reliability in Clinical Processes

IMPACT Learning and Innovation Communities are groups of improvement-minded organizations working together and with IHI to explore new designs and novel solutions to improve care where best practices do not already exist or are not fully developed. Projects last for approximately 10 months under the guidance of an IHI panel of experts, and are open to IMPACT member organizations only.

Designing for Reliability in Clinical Processes is one of six IMPACT Learning and Innovation Communities.

The Challenge

The Solution

In the largest, most comprehensive health care quality study ever conducted in the United States, RAND Health documented that Americans with common health problems receive the "recommended care" just over 50% of the time. This landmark study emphasizes that there are major gaps between best-known science and the care patients actually receive. The authors conclude "the deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public."

Organizations committed to world-class clinical quality are realizing that only by reliably applying evidence-based care can they attain clinical results approaching the theoretical “best” as predicted by the scientific research. Yet becoming reliable brings substantial challenges to organizations and teams as they learn to approach their work in new ways, and build new practices and cultures that support higher reliability. With the advent of pay-for-performance programs and greater transparency regarding clinical performance, designing for reliability will be a critical skill set for all health care organizations.

Reliability theory provides a way to examine a multiple-component system, calculate its overall reliability, and increase the probability that the system will perform its intended function in the required time under commonly occurring conditions. The challenge for health care is to put this theoretical construct into practice.

This Learning and Innovation Community will apply reliability science to evidence-based medicine for clinical diagnoses and processes, with the expectation that measurable improvement in the chosen areas will lead to wider application of reliability practices across the entire organization.

Areas of Focus

During the first year of this community, teams focused on the five diagnoses that make up the Premier/Centers for Medicare & Medicaid Services (CMS) Hospital Quality Incentive Demonstration Project.

Starting in September 2005, new and continuing teams will have the option to focus on dramatically increasing reliability in any clinical diagnosis or process for which clinical evidence already exists and which has been recommended by expert groups or adopted by national organizations (e.g., CMS, JCAHO, NQF).

Aims

Participants will test new ideas to achieve measurable improvements in the reliable application of evidence-based practices for the clinical diagnoses or processes selected. The topics chosen will determine the specific practices being measured, see examples below: