Organizational culture change
Unit-based teams of physicians, nurses, and quality leaders develop and implement unit-specific initiatives designed to improve quality and safety, leading to reductions in infections and pressure ulcers, increased adherence to medication reconciliation standards, more reporting of errors and near-misses, higher patient satisfaction, and better overall nurse/physician communication and teamwork.
A patient-centered medical home features smaller panel sizes and longer visits, pre- and postvisit outreach and care management, close communication and collaboration between physicians and other caregivers, upgrades to and better use of existing technology, and the elimination of productivity-based bonuses, leading to less staff burnout, fewer ambulatory sensitive admissions and emergency department visits, higher physician satisfaction, and improvements in access to and quality of care.
A multifaceted process for full disclosure of medical errors leads to a significant reduction in claims and claim costs for a health system.
As part of a statewide, public-private initiative, a largely rural Vermont community supports its six medical patient-centered medical home practices with a multidisciplinary provider team, real-time electronic information, and insurer-funded financial incentives, leading to more appropriate care and services and lower utilization and growth in health care spending.
As part of a hospital collaborative, intensive care units implemented a multifaceted safety program that reduced infections and hospital days, saved lives, and lowered health care costs.
Integrated primary care teams in medical home clinics, supported by a Web-based portal and personal health records, provide proactive, coordinated care, leading to higher screening rates, better access to care, and improved patient–provider communication.
Seven nursing homes adopted strategies to create a more homelike, resident-focused environment and culture, leading to better quality, higher resident satisfaction, lower staff turnover, and better financial performance.
Adding a nurse practitioner and a multidisciplinary team reduced length of stay and costs at an academic medical center.
A hospital created a new nursing position, the clinical resource nurse, to ensure continuity of care, facilitate care planning, coordinate with physicians, encourage adherence to evidence-based practices, and mentor less experienced nurses, leading to more timely discharges, fewer falls and pressure ulcers, lower nurse turnover, and higher patient, nurse, and physician satisfaction.
An interdisciplinary, comprehensive set of skin care guidelines, combined with support systems to encourage adherence, leads to a substantial reduction in facility-acquired pressure ulcers in hospitalized patients.