Quality improvement tool available for doctors, hospitals

The Institute for Healthcare Improvement's online resource gathers evidence, cost and implementation information on quality and safety initiatives.

By Kevin B. O’Reilly — Posted Oct. 12, 2009

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Physicians and hospitals are under increasing pressure to protect patients from harm. But of the many hospital process changes that could improve quality and safety, which ones should get priority? Which have the best evidence, will be most cost effective and easiest to implement?

The Institute for Healthcare Improvement, a Cambridge, Mass., nonprofit, in late September announced a free Web tool designed to make it easier for doctors, nurses, and quality and safety officials to answer those questions. The IHI Improvement Map, a user-friendly source for data on 70 quality and safety processes, is available at the organization's Web site (link).

"The number of variables that hospitals have to report somewhere as a matter of mandate is hard to pin down, but it's something like 1,500 variables and accountability for 1,500 performance characteristics," said IHI President and CEO Don Berwick, MD. "There is no organization that could do all of that and maintain sanity."

For each quality process listed, the map provides information about the elements of the process, regulatory requirements, standards, guidelines and measures, and links to resources from quality organizations and specialty societies. The map also grades each process on a zero-to-three scale, gauging how strong the evidence is that change will achieve results, how long it would take to implement, how much it would cost, and how difficult it is to implement the process properly.

Mapping a way forward

The IHI's earlier initiatives -- the 100,000 Lives Campaign and the 5 Million Lives Campaign-- focused on a few process changes that hospitals could implement to avoid patient deaths and complications. Similarly, the Improvement Map focuses on a few dozen evidence-based changes in areas ranging from acute delirium prevention to healthy newborn care.

"Some hospitals with a long track record of continuous improvement might work on 20 or 30 or all of these things at once," Dr. Berwick said. "Others might start smaller and pick five or 10 and migrate a way to comprehensive change. At least the map would allow us to be orderly in moving forward."

The Improvement Map could make it easier for doctors and hospitals to make care safer, said Nancy H. Nielsen, MD, PhD, American Medical Association immediate past president.

"We're drowning in demands from every quarter," Dr. Nielsen said during a news conference announcing the Web tool. "The nice thing about this map is that you get to pick and choose what it is that you're going to work on -- what the big problem is in your institution or, perhaps, in your region."

IHI plans to add more information about quality initiatives in ambulatory, long-term care, nursing home care and home health care. Nearly 9,000 people had used the map in the weeks before it was officially announced, Dr. Berwick said.

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