Multifocal Clinical Performance Improvement Across 21 Hospitals

Area of Science:

• Healthcare Management
• Patient Safety
• Clinical Quality Improvement

Background:

• Implementing system-wide quality and safety improvements rapidly is a significant challenge in healthcare.
• Kaiser Permanente Northern California (KPNC) sought to enhance inpatient care quality and safety across its system.

Purpose of the Study:

• To describe KPNC's experience and methodology in achieving widespread inpatient quality and safety enhancements.
• To outline the foundational elements of their successful performance improvement strategy.

Main Methods:

• Utilized a "four-wheel drive" approach to performance improvement.
• Employed a comprehensive driver diagram to align improvement goals with specific focal areas.
• Focused on multiple clinical areas within a short timeframe.

Main Results:

• Achieved substantial improvements in hospital-acquired infections, including central-line–associated bloodstream infections and Clostridium difficile infections.
• Demonstrated significant reductions in patient falls and hospital-acquired pressure ulcers.
• Enhanced safety in high-alert medication use, surgical procedures, sepsis care, critical care, and adherence to The Joint Commission core measures by the end of 2011.

Conclusions:

• A systematic, goal-oriented performance improvement strategy can yield significant, broad-ranging enhancements in inpatient quality and safety.
• The "four-wheel drive" approach and driver diagrams are effective tools for driving system-wide healthcare improvements.
• KPNC's experience provides a scalable model for other healthcare systems aiming to improve patient outcomes and safety.