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1941, William A. Foster
"Quality is never an accident; it is always the result of high
intention, sincere effort, intelligent direction and
skillful execution; it represents the wise choice of
many alternatives.”
Quality Improvement
• “Quality Improvement is a broad range of activities of varying degrees of complexity and methodological and statistical rigor through which … providers develop, implement and assess small-scale interventions and identify those that work well and implement them more broadly in order to improve clinical practice.”
Mary Ann Bailey, The Hastings Center
“By what method?”
W.Edwards Deming
A Breakthrough Series Collaborative underpinned by the Model for Improvement
•A clear aim•Over 40 measures
•Five change packages•Site visits, a listserve, learning sessions
IHI Breakthrough Series Collaborative
Select Topic
(develop mission)
Planning Group
Develop Framework & Changes
Participants (10-100 teams)
Prework
LS 1
P
S
A D
P
S
A D
LS 3LS 2
Supports
Email (listserv) Phone Conferences
Visits Assessments
Monthly Team Reports
A D
P
SExpert Meetings
AP1 AP2 AP3
LS – Learning Session
AP – Action Period
Holding the Gains
IHI Breakthrough Series Collaborative
Select Topic
(develop mission)
Planning Group
Develop Framework & Changes
Participants (10-100 teams)
Prework
LS 1
P
S
A D
P
S
A D
LS 3LS 2
Supports
Email (listserv) Phone Conferences
Visits Assessments
Monthly Team Reports
A D
P
SExpert Meetings
AP1 AP2 AP3
LS – Learning Session
AP – Action Period
Holding the Gains
HSMR – Jan. – Mar. 2012
• Deaths and discharges = 221,674
• Observed deaths = 6401
• Expected deaths = 7167
• HSMR = 6401/7176 = 0.89
9902 fewer than expected deaths since January 2008
902 in this quarter alone
Compiled from reported data by Jason Leitch – September 2012
HSMR: Scotland Jan. ’08 Mar. ‘12
0.80
0.85
0.90
0.95
1.00
1.05
Jan-M
ar 2
008
Apr-Jun 2
008
Jul-S
ep 2
008
Oct-D
ec 2
008
Jan-M
ar 2
009
Apr-Jun 2
009
Jul-S
ep 2
009
Oct-D
ec 2
009
Jan-M
ar 2
010
Apr-Jun 2
010
Jul-S
ep 2
010
Oct-D
ec 2
010
Jan-M
ar 2
011
Apr-Jun 2
011
Jul-S
ep 2
011
Oct-D
ec 2
011
Jan-M
ar 2
012p
HS
MR
1.03
0.89
10.6% reduction
0.00
0.20
0.40
0.60
0.80
1.00
1.20
1.40
1981/8
2
1982/8
3
1983/8
4
1984/8
5
1985/8
6
1986/8
7
1987/8
8
1988/8
9
1989/9
0
1990/9
1
1991/9
2
1992/9
3
1993/9
4
1994/9
5
1995/9
6
1996/9
7
1997/9
8
1998/9
9
1999/0
0
2000/0
1
2001/0
2
2002/0
3
2003/0
4
2004/0
5
2005/0
6
2006/0
7
2007/0
8
2008/0
9*
2009/1
0*
2010/1
1*
2011/1
2*,
p
Year of discharge
% M
ort
ali
ty o
n D
isch
arg
e
Surgical Mortality
35%
0.51%
0.78%
Prepared 1st March 2012
0
0.5
1
1.5
2
2.5
Jan-
08
Apr-0
8
Jul-0
8
Oct-08
Jan-
09
Apr-0
9
Jul-0
9
Oct-09
Jan-
10
Apr-1
0
Jul-1
0
Oct-10
Jan-
11
Apr-1
1
Jul-1
1
Oct-11
General ward C.Difficile rate(per thousand patient days)
1.15
0.12
90% reduction