What Inspires Improvement?

by JHI Staff on December 11, 2013

In our collaborations with health care providers around the world aimed at improving quality, safety and access, every project is unique. But one thing that’s pretty close to universal is encouraging our collaborators to strive for international accreditation. Typically we’ll work with them to achieve Joint Commission International accreditation, which is the most widely recognized hospital accreditation around the world—and one of the toughest to get, too.

We encourage taking such a tough road because it’s not enough to simply hold up general improvement as a goal. We firmly believe that what inspires real improvement in a difficult field requires commitment to a tangible, specific achievement, and a chance to earn a sense of genuine accomplishment at succeeding. For our collaborators, shooting for JCI accreditation serves that purpose. We’ve seen it result in a range of impressive improvements again and again.

In fact, all hospitals, including Johns Hopkins, should be continuously working toward the next level on the improvement scale, no matter the starting point. In our case, we recently set our sights on a particular measure to strive for. Since 2011, the Joint Commission has published a list of hospitals it calculates are “top performers” based on each hospital’s ability to document near-perfect compliance with at least four standard-of-care, evidence-based clinical processes addressing heart attack, surgical care, stroke and other conditions.

For the first two years, no Johns Hopkins Medicine hospital made the list. Why? It’s tempting to make excuses, and we certainly had a few. Compared to most hospitals that made the list, academic medical centers like Johns Hopkins Medicine tend to deal with patient populations that are larger and often sicker, and operate several different hospitals, leading to complex environments in which it can be especially challenging to maintain extraordinarily high rates of process compliance. In fact, almost no medical center or teaching hospital made the list in the first two years; the list was dominated by community hospitals.

But after the publication of the first Top Performer list, our leadership, right up to the level of the president and trustees, firmly and explicitly committed to doing what it takes to make the grade. And with the release of the Joint Commission 2013 report, we learned we succeeded. Not only did our flagship hospital here in Baltimore make the list, but so did two other Johns Hopkins hospitals: Sibley Memorial in Washington, D.C., and All Children’s Hospital in St. Petersburg, Florida.

Here’s an excerpt of what an article about the 2013 Top Performers list in HealthLeaders Media had to say about the Johns Hopkins effort to make the list, quoting our own Peter Pronovost, director of the Armstrong Institute for Patient Safety and Quality, and senior vice president for safety and quality:

Hospital teams made a checklist of why such projects fail, tackling them one-by-one so that performance on process measures for heart attack, heart failure, pneumonia and surgical care all exceed 95%.

For one of the measures, “We reduced the time between arrival and treatment of heart attack patients requiring immediate care from around 90 minutes, the national benchmark, to an average of 66 minutes,” Pronovost said, which required collaboration between emergency responders, interventional cardiologists, nurses and support staff.

“Now, the hospital’s heart attack team is often activated before the patient even reaches the emergency department,” he said.

Clearly, making the needed improvements wasn’t easy. But our teams were inspired by the goal, and rose to the occasion. It’s exactly the sort of inspiration we work hand-in-hand with our collaborators around the world to ignite among their teams, often by getting everyone to rally around the JCI accreditation process.

Our collaborators have, in general, done extremely well in meeting these challenges and achieving accreditation. But outside of our collaborators, there remains a daunting gap between what it takes to be a high-performing hospital that reliably delivers high-quality, safe health care, and what the populations of many parts of the world are getting from their local health care providers. Consider: To make the Joint Commission top performers list, a hospital has to document a 95-percent compliance rate with key clinical processes, many of them involving state-of-the-art medicine. But according to the HealthLeaders Media article, research has shown that just for hand-washing hygiene among clinical care providers in hospitals, the median compliance rate globally is 40 percent.

That gap is why we’re dedicated to working internationally to help health care organizations improve. And we remain dedicated to continuing to improving our own health care delivery at Johns Hopkins Medicine. To make next year’s Top Performer list, hospitals have to document compliance with at least six different clinical processes, rather than only four—and one of the six has to address tough standards for perinatal care. Obviously, we won’t have a chance to rest on our newly won laurels—and we wouldn’t have it any other way.


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Brian Smith December 11, 2013 at 12:27 pm

Can a JCI hospital become a Top Performer? I could not tell reading the Joint Commission information.


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