Holding Providers Accountable for Health Care Outcomes.

Federal public reporting and payment programs have increasingly emphasized the measurement of outcomes (such as readmission, health care-associated infections, and mortality). Yet, the criteria for assessing whether outcome measures are accurate and valid enough to use for public reporting, payment, and accreditation are not well-defined. An outcome measure should be used only if the outcome can be influenced substantially by providers (that is, a strong process-outcome link exists) and statistical adjustment can be made for differences in patient populations across providers so that differences in outcomes are truly attributable to differences in the care provided.

Using the Targeted Solutions Tool® to Improve Hand Hygiene Compliance Is Associated with Decreased Health Care-Associated Infections.

Background: In 2010 Memorial Hermann Health System (MHHS) implemented the Joint Commission Center for Transforming Healthcare's (the Center's) Web-based Targeted Solutions Tool ®(TST ®) for improving hand hygiene through-out its 12 hospitals after participating in the Center's first project on hand hygiene, pilot testing the TST, and achieving significant improvement for each pilot unit. Because hand hygiene is a key contributing factor in health care-associated infections (HAIs), this project was an important part of MHHS's strategy to eliminate HAIs.

Methods: MHHS implemented the TST for hand hygiene in 150 inpatient units in 12 hospitals and conducted a system wide process improvement project from October 2010 through December 2014.

Beyond the collaborative: spreading effective improvement in hand hygiene compliance.

Background: Data assessing the effectiveness of quality improvement (QI) collaboratives are mixed; spreading improvement beyond the original collaborative group has proved difficult. Little is known about whether organizations that did not participate in the collaborative are able to effectively employ interventions developed or implemented by those organizations that did participate.

Methods: The Joint Commission Center for Transforming Healthcare conducted a collaborative QI project with eight hospitals, using Lean, Six Sigma, and change management methods to improve hand hygiene compliance.

Improving hand hygiene at eight hospitals in the United States by targeting specific causes of noncompliance.

Background: Hospitals and infection prevention specialists have attempted to achieve high levels of compliance with hand hygiene protocols for many decades. Despite these efforts, measured performance is disappointingly low.

Methods: The Joint Commission Center for Transforming Healthcare convened teams of experts in performance improvement and infectious disease from eight hospitals for its hand hygiene quality improvement project, which was conducted from December 2008 through September 2010.

Improving the quality of health care: what's taking so long?

Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted.

High-reliability health care: getting there from here.

Context: Despite serious and widespread efforts to improve the quality of health care, many patients still suffer preventable harm every day. Hospitals find improvement difficult to sustain, and they suffer "project fatigue" because so many problems need attention. No hospitals or health systems have achieved consistent excellence throughout their institutions.

Quality of care: how good is good enough?

Israel has made impressive progress in improving performance on key measures of the quality of health care in the community in recent years. These achievements are all the more notable given Israel's modest overall spending on health care and because they have accrued to virtually the entire population of the country.Health care systems in most developed nations around the world find themselves in a similar position today with respect to health care quality.

Hospital performance trends on national quality measures and the association with Joint Commission accreditation.

Background: Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS).

Objectives: To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases.

What the United States could learn from Israel about improving the quality of health care.

In 1999 Israel began to implement a system for monitoring quality of care in its health plans. That system was based largely on a similar system in the United States that, until recently, was associated with steady improvements in performance. However, in recent years health plan quality in the United States appears to have reached a plateau.

The ongoing quality improvement journey: next stop, high reliability.

Quality improvement in health care has a long history that includes such epic figures as Ignaz Semmelweis, the nineteenth-century obstetrician who introduced hand washing to medical care, and Florence Nightingale, the English nurse who determined that poor living conditions were a leading cause of the deaths of soldiers at army hospitals. Systematic and sustained improvement in clinical quality in particular has a more brief and less heroic trajectory. Over the past fifty years, a variety of approaches have been tried, with only limited success.

Controlling healthcare costs by removing waste: what American doctors can do now.

Healthcare costs are unsustainable. The authors propose a solution to control costs without rationing (deliberate withholding of effective care) or payment reductions to doctors and hospitals. Three physician-led strategies comprise this solution: reduce (1) overuse of health services, (2) preventable complications and (3) waste within healthcare processes.

The contribution of geography to black/white differences in the use of low neonatal mortality hospitals in New York City.

Background: Racial differences in the use of high-quality hospital care contribute to racial disparities in mortality for very low birth weight (VLBW) neonates.

Objectives: We explored the role that geographic distribution of hospitals plays in the racial disparity in the use of top-tier hospitals by mothers of VLBW neonates in New York City.

Research Design: Retrospective analysis of Vital Statistics and administrative databases.

Adherence to standards of care by health maintenance organizations in Israel and the USA.

Background: The health-care systems in the USA and Israel differ in organization, financing and expenditure levels. However, managed care organizations play an important role in both countries, and a comparison of the performance of their community-based health plans could inform policymakers about ways to improve the quality of care.

Objective: To compare the adherence to standards of care in Israel and in the USA.

Lack of preparation, physical health after childbirth, and early postpartum depressive symptoms.

Background: Prior research has not examined the association of patient expectations or preparation by providers for the postpartum experience with depressive symptoms. We investigated whether lack of preparation for the postpartum experience and physical health after uncomplicated childbirth were associated with early postpartum depressive symptoms.

Methods: We conducted a telephone survey of 720 early postpartum mothers in New York City.

Improving patient satisfaction with pain management using Six Sigma tools.

Background: Patient satisfaction as a direct and public measure of quality of care is changing the way hospitals address quality improvement. The feasibility of using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) methodology to improve patient satisfaction as it relates to pain management was evaluated.

Methods: This project used the DMAIC methodology to improve patients' overall satisfaction with pain management on two inpatient units in an urban academic medical center.