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Updated: May 20, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Using a logic model to design and evaluate quality and patient safety improvement programs.

Christine A Goeschel¹, William M Weiss, Peter J Pronovost

¹Department of Anesthesiology and Critical Care Medicine, School of Medicine, Armstrong Institute for Patient Safety and Quality, JohnsHopkins University, Baltimore, MD 21231, USA. cgoesch1@jhmi.edu

International Journal for Quality in Health Care : Journal of the International Society for Quality in Health Care

|June 30, 2012

Summary

A quality improvement program successfully reduced central line-associated bloodstream infections (CLABSIs) by 66% in intensive care units (ICUs). This program

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Last Updated: May 20, 2026

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Area of Science:

Healthcare Management
Infectious Disease Prevention
Patient Safety

Background:

Quality improvement programs in healthcare face challenges in project management, intervention evolution, and data collection.
Central line-associated bloodstream infections (CLABSIs) are a significant concern in intensive care units (ICUs).
Previous implementation in 103 Michigan ICUs demonstrated a 66% reduction in CLABSI rates.

Purpose of the Study:

To describe the systematic design, implementation, and evaluation of large-scale quality improvement programs.
To introduce a logical framework approach (LFA) for managing complex healthcare interventions.
To adapt and apply the LFA across diverse international healthcare settings.

Main Methods:

The logical framework approach (LFA) was utilized to guide project management.
The LFA facilitated incorporation of cultural, clinical, and capacity variations across different countries.
Early alignment of project design and evaluation was ensured through the LFA.

Main Results:

The program achieved a 66% reduction in the median CLABSI rate in Michigan ICUs.
The reduction in CLABSI rates was sustained over time.
The program's success led to its expansion to Spain, England, Peru, and other US locations.

Conclusions:

The logical framework approach (LFA) is an effective tool for managing large-scale, multi-faceted quality improvement programs.
The LFA enables systematic design, implementation, and evaluation adaptable to diverse healthcare environments.
This systematic approach supports the successful reduction and sustained improvement of patient safety metrics like CLABSI rates.