"The names of the patients whose lives we save can never be known. Our contribution will be what did not happen to them. And, though they are unknown, we will know that mothers and fathers are at graduations and weddings they would have missed, and that grandchildren will know grandparents they might never have known, and holidays will be taken, and work completed, and books read, and symphonies heard, and gardens tended that, without our work, would never have been."
Donald M. Berwick, MD, MPP, President Emeritus, Institute for Healthcare Improvement
Excerpted from Dr. Berwick's plenary address at IHI's 16th Annual National Forum on Quality Improvement in Health Care (December 2004)
[*Reprinted in: Berwick DM. Promising Care: How We Can Rescue Health Care by Improving It
. "Chapter 2: Some Is Not a Number, Soon Is Not a Time." San Francisco: Jossey-Bass; 2014.]
What was the 5 Million Lives Campaign?
The aim of the 5 Million Lives Campaign was to support the improvement of medical care in the US, significantly reducing levels of morbidity (illness or medical harm such as adverse drug events or surgical complications) and mortality. IHI quantified this aim and set a numeric goal: we asked hospitals participating in the Campaign to prevent 5 million incidents of medical harm over a period of two years (December 12, 2006 through December 9, 2008).
IHI and its partners in the Campaign encouraged hospitals and other health care providers to take the following steps to reduce harm and deaths:
- Prevent Pressure Ulcers by reliably using science-based guidelines for prevention of this serious and common complication
- Reduce Methicillin-Resistant Staphylococcus aureus (MRSA) infection through basic changes in infection control processes throughout the hospital
- Prevent Harm from High-Alert Medications starting with a focus on anticoagulants, sedatives, narcotics, and insulin
- Reduce Surgical Complications by reliably implementing the changes in care recommended by the Surgical Care Improvement Project (SCIP)
- Deliver Reliable, Evidence-Based Care for Congestive Heart Failure to reduce readmission
- Get Boards on Board by defining and spreading new and leveraged processes for hospitals Boards of Directors, so that they can become far more effective in accelerating the improvement of care
The Campaign also continued to offer support to hospitals as they introduced and sustained their work on interventions from the 100,000 Lives Campaign:
- Deploy Rapid Response Teams at the first sign of patient decline
- Deliver Reliable, Evidence-Based Care for Acute Myocardial Infarction to prevent deaths from heart attack
- Prevent Adverse Drug Events (ADEs) by implementing medication reconciliation
- Prevent Central Line Infections by implementing a series of interdependent, scientifically grounded steps called the "Central Line Bundle"
- Prevent Surgical Site Infections by reliably delivering the correct perioperative antibiotics at the proper time
- Prevent Ventilator-Associated Pneumonia by implementing a series of interdependent, scientifically grounded steps including the "Ventilator Bundle"
What was measured in the 5 Million Lives Campaign?
At the Campaign level, we measured two things:
- The number of acute care inpatient deaths that we would expect to occur in the Campaign period (2007 and 2008) given 2006 levels of care, but did not, because of improvements in care (“Lives Saved”)
- The number of incidents of medical harm that we would expect to occur in the Campaign period (2007 and 2008) given 2006 levels of care, but did not, because of improvements in care (“Harm Avoided”)
We collected “lives saved” data through direct submission of acute care inpatient mortality data from participating hospitals. We collected data on “harm avoided” by conducting retrospective chart review in a representative sample of participating facilities.
What were the data submission requirements for the Campaign?
The data submission requirements for the 5 Million Lives Campaign were essentially the same as those for the 100,000 Lives Campaign. There were two components of required data submission:
- Acute Care Inpatient Mortality data (deaths and discharges)
- Submission and periodic update of a “Hospital Profile,” a questionnaire that describes basic administrative and demographic characteristics of your hospital
of organizations fully committed to the 5 Million Lives Campaign by submitting full profile information and mortality data at least through the period of January 2006 through August 2008.
Hospitals are encouraged to continue making the improvements promoted during the 5 Million Lives Campaign and 100,000 Lives Campaign
and are welcome to continue using the Campaign Extranet
, but no longer need to submit their data to IHI.
What were some of the key events during the 5 Million Lives Campaign?
During the 5 Million Lives Campaign, a number of events were held to help support and celebrate the efforts of Campaign participants, including:
- National Action Day: On June 20, 2007, over 35,000 participants joined a virtual meeting for Campaign participants to focus their attention on getting results faster and more reliably.
- Fall Harvest: From October 25 through November 7, 2007, the Campaign celebrated the improvement work of over 3,600 hospitals by “harvesting” the ideas, innovations, and best practices they are using to improve care and reduce harm. The centerpiece of the Fall Harvest was a series of visits by the 5 Million Lives Campaign team, IHI faculty, and staff to hospitals in all 50 states and the District of Columbia. By meeting face to face with frontline improvers, we tapped the energy and ingenuity that was dramatically transforming patient care to share these discoveries with the entire Campaign community.
- National Network Day: On October 27, 2008, the Campaign showcased some of the best and most innovative quality improvement and patient safety work happening in the US.
What did the 5 Million Lives Campaign accomplish?
Participants in the 5 Million Lives Campaign made exciting progress since the launch of the 100,000 Lives Campaign in December 2004. Hospitals across the US made unprecedented commitments to quality and patient safety, with many demonstrating impressive results. At its formal close in December 2008, the Campaign celebrated the enrollment of 4,050 hospitals
, with more than 2,000 facilities pursuing each of the Campaign’s 12 interventions to reduce infection, surgical complication, medication errors, and other forms of unreliable care in facilities. Eight states enrolled 100% of their hospitals in the Campaign, and 18 states enrolled over 90% of their hospitals in the Campaign.
A field office (“Node”) managed local improvement activity in every state, and the Campaign identified 200 hospitals as mentors — teachers of peer facilities on all 12 of the Campaign’s interventions. Every day we witnessed great innovation and activity in the field — there were thirty events around the country in April of 2008 alone.
Above all, we also witnessed striking signs of progress in improving patient outcomes. For example, 65 hospitals reported going a year or more without a ventilator-associated pneumonia, and 35 reported going a year or more without a central line-associated bloodstream infection in at least one of their ICUs. States have also accomplished a great deal; Rhode Island hospitals active in the Campaign reported a 42% decrease in central-line associated bloodstream infections from 2006 to 2007, and New Jersey saw a 70% reduction in pressure ulcers through the work of 150 organizations across the state.
Did hospitals in the Campaign prevent five million instances of harm?
The short answer to this question is that we don’t know yet but IHI is working to better measure progress against its primary aim — massive reduction of patient injuries — through several mechanisms.
First and foremost, IHI completed a state-level harm study to assess patient injuries in a geographic area, North Carolina. IHI sponsored the independent pilot study with the hope that it could serve as a proof of concept for a national study. Researchers focused on validating the methodology for detecting and trending harm over time within an organization, and sought to establish a protocol by which national rates of harm could be measured reliably and accurately.
This study — the North Carolina Patient Safety Study — used the IHI Global Trigger Tool to review a random sample of medical records over a six-year period in a random sample of hospitals in that state. Preliminary indications are that the Global Trigger Tool is a valid, reliable methodology for harm detection in individual hospitals and can be used to track rates of harm over time. The study suggests that a similar approach could be used to measure harm rates nationally.
The study was not powered to detect small changes in the rate of harm over time, but further analyses are ongoing to understand the trends that were observed. The study protocol was developed by two prominent independent health services researchers who work in the patient safety field: Chris Landrigan, MD, MPH (Principal Investigator), and Paul Sharek, MD, MPH (Co-Principal Investigator). Additional input was provided by a distinguished independent Scientific Advisory Group. To ensure objectivity and scientific rigor, an independent Clinical Research Organization — Battelle Inc. — conducted the study. IHI’s hope is that a national health care organization will conduct a national harm study using our pilot results and methodology as a guide, and that this national harm study will not just be a one-time assessment, but rather a continuous measurement project that will provide the country with a reliable metric of progress in this crucial area.
I'm interested in launching a large-scale change initiative like the Campaigns. What resources might help me?
Selected Publications about the IHI Campaigns
The 100,000 and 5 Million Lives Campaigns also helped to inspire other nationwide patient safety and quality improvement efforts around the world. You may also find it useful to learn about some of them:
US: 100,000 Homes
Brazil: Instituto Qualisa de Gestão
Canada: Safer Healthcare Now!
Denmark: Operation Life
Scotland: Patient Safety Alliance
Wales: 1,000 Lives Campaign