All organizations in Pursuing Perfection are changing the role that their leaders play in health care improvement, as well as changing their infrastructures to make quality the central business strategy.
The Cambridge Health Alliance (CHA), in Cambridge, Massachusetts, is a nationally recognized academic public care health system, affiliated with the Harvard Medical School. The Alliance includes three acute care hospitals, over 20 primary care sites, and a statewide managed Medicaid health plan. A unique feature of this organization is that it also includes the Cambridge Public Health Department and is the major safety net provider in this diverse community. Its two initial efforts to pursue perfection are in the management of childhood asthma and the care of adults with diabetes across the community.
Cincinnati Children's Hospital Medical Center (CCHMC) in Cincinnati, Ohio, is an internationally recognized leader in pediatric health care, with a reputation for excellence in patient care, research and medical education. The first pilot project focuses on establishing a comprehensive delivery system for children with chronic illnesses, with an initial focus on patients with cystic fibrosis. The second pilot project is developing a comprehensive strategy for delivering family-centered, evidence-based care to children with acute conditions, with an initial focus on patients with bronchiolitis.
Hackensack University Medical Center (HUMC) in Hackensack, New Jersey, is a 635-bed major tertiary teaching and research hospital affiliated with The University of Medicine and Dentistry of New Jersey — New Jersey Medical School. They are striving to assure that 100 percent of their patients receive all the services indicated by the best medical evidence. Their first two pilot projects focus on chronic illness and safety. The heart failure program is extending the intensive care now required for congestive heart failure (CHF) patients to their homes in order to prevent repeat hospitalizations. Greater patient safety is the target of the anti-coagulation (i.e., blood thinning) service, which has been established to improve the system of care for patients with blood clots. The project reduces the over- and under-use of warfarin (an anti-coagulant), which will decrease bleeding complications and build knowledge about making service delivery safer in the hospital.
The HealthPartners Medical Group and Clinics (HPMG&C) in Bloomington, Minnesota, is one of the largest and most integrated multispecialty group practices in the Twin Cities area. HPMG&C is staffed by more than 550 physicians, providing care to patients at 40 clinic locations. Two hospitals partner with HPMG&C for the Pursuing Perfection initiative: Regions Hospital, a 427-bed facility; and North Memorial Medical Center, a 518-bed facility. The first pilot project will make fundamental changes in the traditional model of providing health care, improving both processes and outcomes of care for all patients with diabetes. A second pilot project will seek aggressive improvement in access for patients requiring primary care and/or specialty care.
In Sweden most health and medical care is public. The County Council of Jönköping is a health care organization for 330,000 inhabitants in 13 municipalities in the south of Sweden. Besides health and medical care, they manage dental care, education, culture, research, public transport, and regional policy regarding business and industry in the region. Eighty-eight percent of their activities concern health and medical care. The County Council has three hospitals with emergency and planned inpatient care; 34 health centres; 35 public dental clinics for general dentistry; 12 clinics for specialist dental treatment, training and research; three clinics for hospital dental care; and a college of Health and Caring Sciences. They have approximately 10,000 employees.
In May 2001, the United Kingdom's National Health Service (NHS) Modernisation Agency (MA) partnered with IHI to bring Pursuing Perfection to England. As part of this effort, four English teams joined the nine US, Swedish, and Dutch teams in the program:
- Bradford Community
- Lambeth and Southwark Community
- Norfolk and Norwich Community
- North and East Devon Community
Based in different geographical areas and serving hundreds of thousands of patients, the Communities provide a wide range of opportunities for the NHS to tackle organizational change and pursue perfection on a nationwide basis.
McLeod Regional Medical Center (MRMC) serves 12 counties in northeastern South Carolina. MRMC provides primary, secondary, and regional tertiary medical and educational services to a population of nearly one million people. More than 4,000 employees, 350 physicians, and 36 medical practices make up MRMC. One of MRMC's pilot programs will focus on eliminating adverse drug events, capitalizing on enhancements in paperless technology and providing extensive training to medical and hospital staff. Additionally, MRMC will implement best practices for treating heart disease, concentrating on patient identification, disease management, and patient and medical technology.
The Reinier de Graaf Group (RdGG) in Delft, The Netherlands is a general hospital that cares for over 400,000 residents in Delft, the Westland, Voorburg, Rijswijk, The Hague-southwest, Pijnacker and Nootdorp. For years RdGG has distinguished itself by its policy on quality. This is acknowledged both nationally and internationally. The importance of awareness of the quality in the stream of daily activities and problems is considerable. In 2000 major steps have been taken to involve each employee in the improvement that they would like to achieve. In this they surely can include the introduction of the INK-model for measurement and improvement of quality and the commencement of accreditation of the hospital according to NIAZ qualifications in 2005.
Tallahassee Memorial HealthCare (TMH) in Tallahassee, Florida, is a private, not-for-profit, integrated health care system. The system is licensed for 770 beds, including a tertiary hospital, a behavioral health hospital, a subacute facility, a long-term care facility, a home health agency, 12 primary care clinics in seven surrounding counties, and a family practice residency program. TMH is conducting two pilot projects with partner Capital Health Plan (CHP), a single-site, mixed-model HMO with the same primary service areas as TMH. The first pilot project completely redesigns the medication system, focusing on all phases of medication management, including computerized physician order entry (CPOE), automated dispensing, an online medication administration record (MAR), barcoding, and a medication error and near-miss reporting system. The second pilot project is aimed at redesigning cardiovascular services to reduce mortality and costs of care.
PatientPowered is a community coalition in Washington State that is seeking nothing less than perfect care for residents of Whatcom County, Washington, focusing on the management of chronic illness both in and out of the hospital. The first two pilot projects will address the chronic illnesses with the greatest burden in the community — diabetes and cardiovascular disease in the form of congestive heart failure. The coalition is seeking improved function for these patients, greater satisfaction, and decreased use of expensive hospital care.
