Organizational culture change
The Billings Clinic, an integrated health system in Billings, MT, addressed its rising rate of methicillin-resistant Staphylococcus aureus infections by making infection control a top institutional priority and by creating a comprehensive package that combines adoption and monitoring of strict infection control protocols, active surveillance, training and education, and the solicitation and implementation of employee ideas through an approach known as “positive deviance.” This term refers to the focus on uncommon strategies that lead to positive changes and results.
The Hasbro Children's Partial Hospital Program—a medical treatment day program for children ages 6 to 18 years old who have chronic medical illnesses and emotional issues—has demonstrated sustained positive outcomes of treatment on several measures, including quality of life, emotional symptoms, and family beliefs about illness.
Magee-Womens Hospital of the University of Pittsburgh Medical Center implemented the Patient and Family Centered Care Methodology and Practice, a low-technology, systems-based approach to inpatient care that focuses on providing care from the patient's and family's perspective; the program is associated with high rates of patient satisfaction, functional status, and adherence to evidence-based care protocols, along with low infection rates and length of stay.
Aurora Health Care spearheaded a community-wide medication reconciliation initiative, involving health care consumers, providers, pharmacists, and community stakeholders, to improve the accuracy of elderly patients' medication lists.
The University of Pittsburgh Medical Center Shadyside implemented a Condition Help program that patients or their family members can activate via a telephone call when the patient's condition is deteriorating; the call immediately brings in a rapid response team to assess and manage the situation and provide treatment as needed.
The medical response team at Baptist Memorial Hospital in Memphis, TN, responds to early warning signs that patients are in cardiac or respiratory distress and moves quickly to rescue them before medical emergencies develop; the team has reduced cardiac arrests by 26 percent.
A new change mode helps emergency departments redesign patient flow processes so that a clinical team rapidly triages each patient, allowing for accelerated treatment of less sick patients and faster admission for those who are very ill.
A nurse specialist maintains regular telephone contact with the primary caregivers and health care providers of premature infants with chronic lung disease who are discharged from the hospital.
Reid Hospital created a computer-based system of alerts, standing orders, and care pathways to eliminate gaps in the care of patients with pneumonia, acute myocardial infarction, and heart failure, and to address surgical complication and infection prevention, leading to significant improvements in quality of care.
A partnership between a hospice organization and an 11-location multispecialty group practice places palliative care nurses in primary care clinics to monitor dying patients' medical and social care needs, coordinate community services, and discuss end-of-life issues.