Cincinnati Children's Hospital Medical Center: transforming care for children and families.

BACKGROUND: Cincinnati Children's Hospital Medical Center pursues its vision to be the leader in improving child health through the creation of new knowledge, education of professionals and the community, and transformation of our health care delivery system. OVERALL APPROACH TO QUALITY AND SAFETY: The strategic plan focuses on achieving the best medical and quality of life outcomes, patient and family experience of care, and value through horizontal integration of research and delivery system design, thereby accelerating the transfer of new knowledge to the bedside. CREATING QUALITY FROM THE FAMILY PERSPECTIVE: Family members and patients participate at all levels of the organization, from the organizationwide family advisory council, to unit-based inpatient teams, to serving as family faculty who teach pediatric residents and orient new employees. Family members ensure that children's and parents' voices are heard. DISCUSSION: Key factors contributing to ongoing transformation include senior leaders' drive for change, focus on perfection or near-perfection goals, vertical alignment in measures, accountability, improvement capability, commitment to internal and external transparency, and focus on measurement and constancy of purpose.

Individualized daily schedules for hospitalized adolescents with cystic fibrosis.

INTRODUCTION: This article describes the effects of an individualized patient schedule on satisfaction and clinical outcomes for patients with cystic fibrosis admitted to an adolescent unit. METHOD: Data on airway clearance treatments, physical therapy attendance, and school attendance were collected for patients who used the individualized schedule and for historic controls. Patients who were admitted following implementation of the schedule were asked to complete a brief survey about their inpatient care shortly before or after hospital discharge. RESULTS: Patients who used the schedule were more likely to report that their care was often or always delivered exactly as they expected and to believe that they were involved in care decisions as much as they wanted to be. Eighty-seven percent believed that using the individualized schedule made their stay a little or much better compared to past hospitalizations. There was no change in physical therapy, airway clearance, and school attendance. DISCUSSION: Engaging hospitalized adolescents with cystic fibrosis in the design of their individualized daily schedule is a win-win proposition, resulting in improved satisfaction while maintaining clinical outcomes.

A case study of pediatric asthma alerts from the beacon community program in cincinnati: technology is just the first step.

INTRODUCTION: The Beacon Community in Cincinnati, Ohio was an innovative, community-wide initiative to use technology to transform care. One important feature was the development of regional alerts to notify practices when patients were hospitalized or seen in the emergency department. The purpose of this paper is to describe the way in which technology engages the improvement process, and to describe the early stages of learning how to use technology to enhance quality improvement. METHODS: We interviewed key Beacon leaders as well as providers and office staff in selected practices. We also collected preliminary data from practices that reflected handling of alerts, including the number of asthma related alerts received and followed up. RESULTS: Regional alerts, supplied by the community-wide health information exchange, were a significant addition to the quality improvement effort in that they enabled practices to identify and follow up with additional children at risk. An important finding was the substantial effort at the practice level to integrate technology into ongoing patient care. CONCLUSIONS: Developing the technology for community wide alerts represented a significant endeavor in the Cincinnati Beacon Community. However, the technology was just the first step. Despite extra effort and time required on the part of individual practices, they reported that the value of having alerts was high. Hospital and ED visits represent some of the most costly aspects of care, and an efficient process for intervening with children using these costly services was seen as of significant value.