Institute for Healthcare Improvement: Innovation Community: Improving Reliability in Key Clinical Areas

Overview

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.

IHI thanks Premier, Inc. for generously supporting the development of this Innovation Community.

Click here to listen to an informational call led by the faculty of this Innovation Community.

The Problem

The Solution

In the largest, most comprehensive health care quality study ever conducted in the United States, RAND Health has 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 of the study conclude that, "The deficits we have identified in adherence to recommended processes for basic care pose serious threats to the health of the American public."

The consistent application of evidence-based care has been an area of concern among health care professionals and quality improvement advisors for decades. The health care system is extremely complex, and the consistent application of scientifically grounded best practices has, to date, not been its strongest suit. As a result, patients cannot expect to always receive evidence-based, effective care when they need it.

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 apply this theoretical construct into practice.

This Innovation Community will apply reliability science to evidence-based medicine in five key clinical diagnoses, with the expectation that measurable improvement in these areas will lead to wider and consistent application of reliable practice across the entire organization.

Areas of Focus

This Innovation Community will focus on dramatically increasing reliability in five clinical diagnoses:

Acute Myocardial Infarction (AMI)
Coronary Artery Bypass Graft (CABG)
Heart Failure
Community-Acquired Pneumonia
Hip and Knee Replacement

These diagnoses are aligned with the Premier/Centers for Medicare & Medicaid Services (CMS) Hospital Quality Incentive Demonstration Project, a three-year program designed to determine if economic incentives are effective at improving the quality of inpatient care.

Participation in the Premier/CMS Demonstration Project is not a prerequisite for participation in this Innovation Community. Participants will implement a three-level design for safe and reliable systems:

Prevention: Design the system to prevent failure
Identification: Design and implement procedures and relationships to make failures visible when they do occur so that they may be intercepted before causing harm
Mitigation: Implement procedures and build capabilities for mitigating the harm caused by failures when they are not detected and intercepted

Aims

Participants will test new ideas in an effort to achieve measurable improvements in the reliable application of evidence-based procedures for the diagnoses selected. For example, the following process measures will be tracked for Heart Failure:

Left ventricular function (LVF) assessment
Detailed discharge instructions
ACE inhibitor for left ventricular systolic dysfunction (LVSD)
Smoking cessation advice/counseling
For Hip and Knee Replacement, the following process and outcome measures will be emphasized:
- Prophylactic antibiotic received one hour prior to surgical incision
- Prophylactic antibiotic selection for surgical patients
- Prophylactic antibiotics discontinued within 24 hours of surgery end time
- Postoperative hemorrhage or hematoma
- Postoperative physiologic and metabolic derangement
- Readmissions 30 days post-discharge

To Participate

To join an Innovation Community, you must be a member of IHI's IMPACT network and have completed at least one successful improvement project within your organization. See IMPACT Network for more details about this exciting network of organizations collaborating for results.