Jordan Bohnen

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• Jordan Bohnen
• Institute for Healthcare Improvement
• Cambridge, Massachusetts
• The SHN-CAPHC Paediatric Medication
  Reconciliation Orientation and Training Workshop
• August 9th, 2005

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What are the Institute for Healthcare Improvement
(IHI) and the 100,000 Lives Campaign?
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The IHI is

• A healthcare quality improvement think-tank
• Cambridge-based non-profit, founded in 1991.
• Dedicated to improving the quality of health care
  systems around the world through education,
  research, demonstration projects, and the
  promotion of collaboration among health care
  organizations.
• 70 staff members, hundreds of expert faculty
  around the world, projects extend throughout the
  U.S. and Canada, in a number of European
  countries, the Middle East, and Africa.
•  

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IHIs Mission

• To accelerate the measurable and continual
  progress of health care systems throughout the
  world
• To aim for health care for all with(the No
  Needless List )
• No needless deaths  No needless pain or
  suffering  No helplessness in those served or
  serving  No unwanted waiting  No waste

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What does IHI do?

• Breakthrough Series Collaboratives
• PDSA rapid-cycle improvement
• Impact Network
• Test new improvement ideas
• Online and Live Improvement Courses
• Pursuing Perfection
• Multi-million dollar grants to hospitals willing
  to adopt universal approach to quality
  improvement
• Annual National Forum on Quality Improvement in
  Healthcare

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Dr. Donald Berwick Leader with a Vision

• Donald M. Berwick, MD, MPP, IHI President and
  CEO. Clinical Professor of Pediatrics and Health
  Care Policy at the Harvard Medical School.
  Pediatrician, Associate in Pediatrics at Bostons
  Childrens Hospital and a Consultant in
  Pediatrics at Massachusetts General Hospital.
• Elected member of the Institute of Medicine of
  the National Academy of Sciences.
• Served on President Clintons Advisory Commission
  on Consumer Protection and Quality in the
  Healthcare Industry in 1997 and 1998.
• Listed in industry publication Modern Healthcare
  in 2002 as the 3rd most powerful person in
  American health care, behind Tommy Thompson,
  Secretary of Health and Human Services, and
  Thomas Scully, head of Medicare and Medicaid.

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Dr. Berwick

• International authority on healthcare quality
  improvement
• A visionary for his conviction and innovative
  methods of addressing systems challenges
• Every system is perfectly designed to achieve
  exactly the results it gets
• Dr. Donald Berwick

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QI/Patient Safety Movement gains momentum...

• To Err is Human IOM, 2000
• Systems, not individuals, responsible for most
  deficiencies in quality
• Between 44,000-98,000 Americans die each year due
  to medical errors

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QI/Patient Safety Movement gains momentum...

• Crossing the Quality Chasm IOM 2001
• Quality lacking in many dimensions, which
  contribute to preventable mortality and injury
  rates
• 6 aims for improvement Safety, Effectiveness,
  Patient-Centeredness, Timeliness, Efficiency,
  Equity
• McGlynn et al. study NEJM, 2003
• Of 6,712 patients, 54.9 received recommended
  care based on 439 indicators of clinical quality
• Baker/Norton et al. Canadian Adverse Events
  study CMAJ, 2004
• 7.5 of hospital admissions result in an adverse
  event (unintended injury), 37 of which judged
  highly preventable
• Between 9,250-23,750 annual preventable deaths
  from adverse events

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IHIs Conclusions

• There are serious problems in quality
• - over 1,000,000 adverse events at a cost of 50
  B/yr
• Between the health care we have and the care we
  could have lies not just a gap but a chasm.
  (IOM, 2001)
• The problems come from poor systemsnot bad
  people
• -In its current form, habits, and environment,
  American health care is incapable of providing
  the public with the quality health care it
  expects and deserves.
• We can fix it but it will require large-scale
  changes

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The Response
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National Initiatives 100K LivesWhy a Campaign
now?

• Enough of the What
• Time for the How
• Growing impatience with inaction
• Put improvement theory and evidence-based
  research into action
• Spread improvements with increased order of
  magnitude

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Campaign Objectives and Timeline

• Enroll 1,600 hospitals
• Save 100,000 Lives
• Build a reusable national infrastructure for
  change
• First national QI initiative of its kind
• Increase awareness of Quality and Safety problems
• Change culture
• Future campaigns?
• Start Date December 14th, 2004, 9 am
• End Date June 14th, 2006, 9 am
• 18 months

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Campaign Field Operations Structure
IHI and Campaign Leadership
Ongoing communication
NODES (approx. 75)
Each Node Chairs 1 Network
FACILITIES (2000-plus)
30 to 60 Facilities per Network
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Campaign Principles

• Some is not a number. Soon is not a time.
• Campaign prompts immediate action. Set targets
  and deadlines, like in an election.
• Welcome anyone at any level
• Free enrollment, voluntary implementation
• Free resources to aid implementation and
  measurement
• We do this together
• Participants, Nodes, Partners, Financial
  supporters
• The Campaign starts with you
• Individual efforts combine to produce significant
  improvements

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How will lives be saved?

• 6 evidence-based interventions, supported in the
  scientific literature
• Deploy Rapid Response Teams, or Emergency Medical
  Teams (first site of patient decline)
• Prevent Adverse Drug Events (medication
  reconciliation)
• Deliver reliable AMI care (prevent heart attack
  deaths)
• Prevent Surgical Site Infections (correct
  peri-operative antibiotics)
• Prevent Ventilator Associated Pneumonia (bundle)
• Prevent Central Line Infections (bundle)

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Prevent Ventilator-Associated Pneumonia

• 4 Key components of the ventilator bundle
• Elevate head of the bed to between 30-45 degrees
• Daily sedation vacation and daily assessment of
  readiness to extubate
• Peptic ulcer disease prophylaxis
• Deep vein thrombosis prophylaxis unless
  contraindicated

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How do we measure lives saved?

• Voluntary reporting of intervention-level data
  (process)
• Hospital Standardized Mortality Ratios (HSMR)
  aka. hospital death rates - used to compare
  participants to controls (outcome)

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Campaign Updates

• Over 2,500 hospitals enrolled in all 50 states
  (over 50 U.S. hospital beds)
• Approx. 75 nodes (regional offices), including
  paediatric
• Vibrant partnerships
• NPSF, AAMC, AHRQ, AMA, ANA, VHA, CMS, CDC, JCAHO,
  Leapfrog, Ascension, AHQA, NRHA, NC State Hosp.
  Assoc., Premier, Qualis, SSM, UHC, VA
• Paediatric assocations NICHQ, NACHRI, CHCA

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Campaign Updates II

• Focus on Implementation Pilot Group, Getting
  Started Kits, Conference Calls, Faculty experts,
  Online tools
• Media hype local, statewide success stories
• Thousands on national calls
• Related campaigns forming globally
• Straightforward online national data collection

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Campaign Updates
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Upcoming Events

• Currently in implementation phase
• Just finished 1st round data collection
• July/August Round Two of National Calls on each
  intervention
• July/August Nationwide Summer Tour
• October Coast-to-Coast Campaign Bus Tour
• Milestone learning meetings in December (Forum)
  and June of 2006 (Celebration)

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Parting Words

• 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 Berwick, IHI National Forum, Dec 14,
  2005