An MPJP Contemplates Charism, Calling and the Future.

The story of Catholic health care spans generations, continuing to serve as an unbroken link to the healing ministry of Jesus. Through the Spirit's creative provision, the unique charisms that strengthened and sustained the sisters and brothers who went before us continue today in the hearts and minds of lay and religious alike.

The quality 'journey' at Ascension Health: how we've prevented at least 1,500 avoidable deaths a year--and aim to do even better.

A decade ago the Institute of Medicine estimated that 44,000-98,000 preventable deaths occur each year in US hospitals. The leaders of Ascension Health-one of the nation's largest health care delivery networks, with sixty-nine hospitals in twenty states and the District of Columbia-dedicated themselves to preventing equivalent numbers of deaths in their system. In 2003 they set a goal of reducing preventable deaths by 900 each year by 2008. By fiscal year 2010 Ascension Health had reduced preventable deaths by more than 1,500 people annually and, by some calculations, by more than 5,000 people annually, compared to 2004. Ascension Health had also achieved important improvements in preventing birth trauma and reducing rates of pressure ulcers and hospital-acquired infections. The health care system could achieve even greater results by adopting the safety principles used in high-reliability entities such as the nuclear power industry. The adoption of such principles can lead to impressive improvements in health care quality.

The Ascension Health journey to zero: lessons learned and leadership.

BACKGROUND: In 2002, Ascension Health, a 65-hospital nonprofit health care system, articulated a call to action to provide Healthcare That Works, Healthcare That Is Safe, and Healthcare That Leaves No One Behind. The goal is to provide excellent clinical care with no preventable injuries or deaths by July 2008. Just months from this target date, substantial reductions in events related to eight priorities for action have been documented, and at the current rate more than 2,000 lives a year are being saved compared to the baseline mortality rate. BUILDING THE AGENDA FOR CHANGE: Progress toward the goal of zero preventable injuries or deaths required transformational change. Key steps toward this change included establishing a sense of urgency, creating a guiding coalition (the clinical excellence team), and developing the Destination Statement II. Other key factors in our early success included methods of process and outcomes measurement, the formation of appropriate and diverse leadership groups comprised of primary stakeholders, methods of knowledge transfer, and the involvement and leadership of the Ascension Health Quality Committee and individual health ministry Boards. THE JOURNEY CONTINUES: An ongoing discussion of what "zero preventable deaths and injuries" really means has led to the identification of additional interventions to further reduce preventable injuries and deaths.

Teamwork in the operating room: frontline perspectives among hospitals and operating room personnel.

BACKGROUND: The Joint Commission on Accreditation of Healthcare Organizations is proposing that hospitals measure culture beginning in 2007. However, a reliable and widely used measurement tool for the operating room (OR) setting does not currently exist. METHODS: OR personnel in 60 US hospitals were surveyed using the Safety Attitudes Questionnaire. The teamwork climate domain of the survey uses six items about difficulty speaking up, conflict resolution, physician-nurse collaboration, feeling supported by others, asking questions, and heeding nurse input. To justify grouping individual-level responses to a single score at each hospital OR level, the authors used a multilevel confirmatory factor analysis, intraclass correlations, within-group interrater reliability, and Cronbach's alpha. To detect differences at the hospital OR level and by caregiver type, the authors used multivariate analysis of variance (items) and analysis of variance (scale). RESULTS: The response rate was 77.1%. There was robust evidence for grouping individual-level respondents to the hospital OR level using the diverse set of statistical tests, e.g., Comparative Fit Index = 0.99, root mean squared error of approximation = 0.05, and acceptable intraclasss correlations, within-group interrater reliability values, and Cronbach's alpha = 0.79. Teamwork climate differed significantly by hospital (F59, 1,911 = 4.06, P < 0.001) and OR caregiver type (F4, 1,911 = 9.96, P < 0.001). CONCLUSIONS: Rigorous assessment of teamwork climate is possible using this psychometrically sound teamwork climate scale. This tool and initial benchmarks allow others to compare their teamwork climate to national means, in an effort to focus more on what excellent surgical teams do well.

The clinical transformation of Ascension Health: eliminating all preventable injuries and deaths.

BACKGROUND: In 2002 Ascension Health, a 67-hospital not-for-profit health care system, articulated a call to action to provide excellent clinical care with no preventable injuries or deaths by July 2008. It embarked on a journey of clinical transformation. Transformational change implies a much greater pace of change than that reflected in traditional, incremental change processes. THE JOURNEY BEGINS: Progressing from vision to action plan required setting the clinical transformation agenda, identifying challenges to this agenda, and establishing measurements of progress. Environmental changes that must be addressed to successfully implement a transformational change process include culture, making the business case, infrastructure investments, standardization, and how we work together. TAKING ACTION: Improvement activities focused on eight priorities for action, including preventable mortality and areas such as adverse drug events, falls, and surgical complications. "Alpha" sites would develop the best clinical and implementation practices for eliminating the preventable adverse events related to these areas. EARLY RESULTS: The observed decrease in the mortality rate among non-end-of-life-care patients was 21% (p < .001), exceeding the 15% goal set for July 2008 and corresponding to 1,200 deaths prevented across the system. The alpha sites reported initial results in June 2004, with more than 50% reductions in adverse events for all the priorities for action areas.