Creating a high-reliability health care system: improving performance on core processes of care at Johns Hopkins Medicine.

In this article, the authors describe an initiative that established an infrastructure to manage quality and safety efforts throughout a complex health care system and that improved performance on core measures for acute myocardial infarction, heart failure, pneumonia, surgical care, and children's asthma. The Johns Hopkins Medicine Board of Trustees created a governance structure to establish health care system-wide oversight and hospital accountability for quality and safety efforts throughout Johns Hopkins Medicine. The Armstrong Institute for Patient Safety and Quality was formed; institute leaders used a conceptual model nested in a fractal infrastructure to implement this initiative to improve performance at two academic medical centers and three community hospitals, starting in March 2012. The initiative aimed to achieve ≥ 96% compliance on seven inpatient process-of-care core measures and meet the requirements for the Delmarva Foundation and Joint Commission awards. The primary outcome measure was the percentage of patients at each hospital who received the recommended process of care. The authors compared health system and hospital performance before (2011) and after (2012, 2013) the initiative. The health system achieved ≥ 96% compliance on six of the seven targeted measures by 2013. Of the five hospitals, four received the Delmarva Foundation award and two received The Joint Commission award in 2013. The authors argue that, to improve quality and safety, health care systems should establish a system-wide governance structure and accountability process. They also should define and communicate goals and measures and build an infrastructure to support peer learning.

Life and liberty: the power of positive purpose.

The authors believe that health care and the courts, through their commitments to positive purpose, are the fundamental keepers of life and liberty in American society. In fact, they postulate that the power of positive purpose works in every sector-public, private, and not-for-profit. More specifically, by the use of data, operational examples, and cases, this article shows how high performing hospitals, courts, and other organizations make optimism tangible by developing concepts, theories, and policies based on positive values. Effective court and hospital leaders take the abstractions and hopes of wishes and dreams and make them concrete and operational in a caring, sensitive, and humane way. Increasingly with the new generation of employees, loyalty and motivation are based more on affirmative values anchored in empowerment, participation, involvement, and spirituality than on cash. Leaders in health care and the courts must possess and be able to communicate a clear set of positive values to these individuals. Consequently, the authors show that we in health care and the court arena can influence the events in our personal lives and in our organizations' lives by making the values, visions, and cultural anchors in our organizational settings the foundations of performance. Strong leadership that ties the organizational goals to uplifting values based on a committed sense of optimism is the key to confronting creatively the philosophical, strategic, organizational, and operational changes necessary to improving the institutional effectiveness of health care and the law as we move into the new millenium. As reflective-practitioner leaders, it is our responsibility to be the catalysts and role models for our professional colleagues by retaining, communicating, and demonstrating a profound sense of optimism and a high level of performance in judicial and health care organizations.