The Power of Humility.

Consistently high-performing health systems and hospitals have one key trait in common: humility.

More quality measures versus measuring what matters: a call for balance and parsimony.

External groups requiring measures now include public and private payers, regulators, accreditors and others that certify performance levels for consumers, patients and payers. Although benefits have accrued from the growth in quality measurement, the recent explosion in the number of measures threatens to shift resources from improving quality to cover a plethora of quality-performance metrics that may have a limited impact on the things that patients and payers want and need (ie, better outcomes, better care, and lower per capita costs). Here we propose a policy that quality measurement should be: balanced to meet the need of end users to judge quality and cost performance and the need of providers to continuously improve the quality, outcomes and costs of their services; and parsimonious to measure quality, outcomes and costs with appropriate metrics that are selected based on end-user needs.

Controlling healthcare costs by removing waste: what American doctors can do now.

Healthcare costs are unsustainable. The authors propose a solution to control costs without rationing (deliberate withholding of effective care) or payment reductions to doctors and hospitals. Three physician-led strategies comprise this solution: reduce (1) overuse of health services, (2) preventable complications and (3) waste within healthcare processes. These challenges know no borders.

Building and sustaining a systemwide culture of safety.

BACKGROUND: In 2002, Sentara launched a systemwide initiative to significantly reduce events of harm to patients and employees. The initiative began at Sentara Norfolk General Hospital. Since then, the safety principles piloted there have been instituted throughout Sentara's integrated health care system of hospitals, nursing homes, and physician practices. ACCELERATING THE PACE OF IMPROVEMENT: Implementation at each local site begins with a thorough assessment of its safety culture. Four core areas of focus include (1) establishing safety as a core value, (2) creating Behavior-Based Expectations (BBEs) for error prevention that are tailored for staff, leaders, and physicians, (3) developing a state-of-the-art root and common-cause analysis program, and (4) implementing an approach to focus and simplify work processes and procedure documentation. KEYS TO SUCCESS: Senior leadership demonstrated a commitment to making safety a core value by embedding safety into strategic priorities, incentives, rewards and recognition, and human resources policies and procedures; prioritization of operational goals to ensure the availability of time and resources to make the safety initiative the key focus; involvement of employees and medical staff each step of the way; establishment of site-based safety initiative teams of operational leaders with the responsibility for leading the safety initiative implementation and ensuring effective communication across the organization; and a willingness to learn and try successful techniques from high-reliability organizations outside health care.

Sentara Norfolk General Hospital: accelerating improvement by focusing on building a culture of safety.

BACKGROUND: To accelerate progress in improving patient safety, Sentara Norfolk General Hospital (SNGH) supplemented its improvement programs with an initiative to strengthen its organizational culture of safety. CREATING A CULTURE OF SAFETY: SNGH established and intternalized behaviors in the organization that would result in safer and more reliable and productive human erformance. Four areas of focus were identified: (1) creating Behavior-Based Expectations (BBEs) for error prevention for all positions, (2) establishing Red Rules to focus employees on rules with the highest level of consequence and risk if not followed exactly, (3) develping a technically based Root Cause and Common Cause Analysis process, and (4) implementing an appproach to focus and simplify policies and procedures. KEYS TO SUCCESS: The senior leadership made the safety initiative the number-one priority; operational goals were prioritized to ensure the availability of time and resources for the safety initiative. A team of five operational leaders led implementation and ensured efffective communication across the organization. Medical staff provided support to the safety initiative; for example, it developed and implemented its own BBEs list. Finally, employees were engaged in all phases of the initiative. SNGH's largest challenge remains to continue to accelerate improvement while simultaneously holding gains previously made.