Every week for the last three years, Dr. James Moses has
driven from Boston Medical Center (BMC) to IHI's office in Cambridge. As the
IHI Open School's Academic Advisor, he helps our team determine priorities, develop
content, and engage our community of learners around the world.
Last week, for the first time, we went to visit him.
Dr. Moses is a pediatrician and the Medical Director of
Quality Improvement at BMC, a safety net hospital with 496 beds and about 6,000
employees. He invited our entire team — Carly, Jess, Laura, Andy, Rachel, Mike,
Stephanie, Gina, and Gaby — to the hospital for a day of tours and meetings
with quality directors, risk managers, and other staff.
The site visit was, in short, one of the best learning
experiences we've had. We heard about the day-to-day challenges of engaging
clinicians in quality improvement and saw colleagues supporting each other to take
better care of patients. It was inspiring.
Collectively, we came up with 11 takeaways from our great
day at BMC:
- No one, no matter
how hungry, wants to grab the first sandwich at a lunch meeting.
- BMC hired its first Chief Quality Officer in
2008, the same year IHI created the Open School. We were delighted to hear
how many BMC staff have taken our courses or
other IHI programs — and recommend them!
- Reporting medical
errors is a project in itself. Years ago, BMC commissioned an independent review that found staff
reported only about 12 percent of errors. By convincing staff that error
reporting is meant to help patients rather than punish clinicians, BMC is now
one of the top reporting hospitals in Boston.
- When errors are
reported, risk managers always make sure the provider is okay in addition
to patients and their families. Clinicians in these events
are sometimes called “second victims.”
- We aren’t the only
ones who love inspirational quotes in our work space. Our meetings took
place under Dr. Don Berwick’s familiar rallying cry for improvement.
- Twice a year, the
BMC quality improvement team issues a call for improvement projects,
receives about 20 proposals, and selects a handful to support directly. Quality
improvement specialists meet with the front-line team to work on the project every
week. Not quarterly. Not monthly. Every week.
- Improvement is boundariless. Ideas come from everyone, everywhere in the system. We heard
about a wonderful improvement project involving housekeeping staff that, to
call out one PDSA cycle, aimed to make sure trash baskets in patient rooms were
never more than 3/4 full.
- A huge barrier to
involving residents in quality improvement is their limited time with each
unit. Projects last many months, but residents’ rotations last only a few
- At BMC, trainees
spend a one-week rotation with the risk management department. Trainees are
amazed at how much goes on behind the scenes, and many say the experience
changes the way they practice medicine.
- BMC’s quality
improvement specialists go beyond the Model for Improvement. They incorporate lean thinking, including a problem-solving tool called
- Patient care
comes first. Clinicians are always busy responding to immediate needs, and
they have to carve out time for quality improvement work. Being improvement
people, we often forget it’s their other
Many thanks to Dr. Moses and all our friends at BMC for