Michigan ICU reduces infections through process improvement
A teamwork approach was key to the success of a Michigan program that improved patient care in more than 100 hospital intensive care units (ICUs), dramatically reducing the rates of potentially deadly central line bloodstream infections, according to study findings published in the June issue of Milbank Quarterly.
“Explaining Michigan: developing an ex-post theory of quality improvement program,” by Mary Dixon-Woods, MSc, DPhil, and Emma-Louise Aveling of the University of Leicester; along with researchers from the University of Pennsylvania in Philadelphia John Hopkins University in Baltimore, explored the successful approach to quality care implemented in Michigan ICUs.
“We knew the program worked. It not only helped to eliminate infections, it also reduced patient deaths,” said program leader Peter J. Pronovost, MD, PhD, of the departments of anesthesiology/critical care medicine and surgery at Johns Hopkins School of Medicine in Baltimore. “The challenge was to figure out how it worked.”
The Michigan program “explicitly outlined what hospitals had to do to improve patient safety, while leaving specific requirements up to the hospital personnel,” researchers found. Another critical aspect of the program was convincing participants that there was a problem they could solve.
“It was achieved by a combination of story-telling about real-life tragedies of patients who came to unnecessary harm in hospitals, and using hard data about infection rates,” said co-author Charles L Bosk, PhD, a sociology professor in School of Arts and Sciences at the Unversity of Pennsylvania.
The supportive atmosphere of the hospital team enabled doctors and nurses to “learn together, share good practice, and exert positive pressure on each other to achieve the best outcomes for patients,” noted lead author Dixon-Woods.
“What we have learned is that it is the local teams that deliver the results,” said Bosk. “But they need to be well-supported by a core project team, who have to focus on enabling hospital workers to get things right. That means providing them with scientific expertise to justify the changes they are being asked to make, and standardizing measures so they are all collecting the same data. It also means trying to figure out why simple changes that make life better are so difficult for health care delivery systems to do. Getting the whole program to work, rather than compliance with a single one component, is the key to making health care safer for patients.”
“Explaining Michigan: developing an ex-post theory of quality improvement program,” by Mary Dixon-Woods, MSc, DPhil, and Emma-Louise Aveling of the University of Leicester; along with researchers from the University of Pennsylvania in Philadelphia John Hopkins University in Baltimore, explored the successful approach to quality care implemented in Michigan ICUs.
“We knew the program worked. It not only helped to eliminate infections, it also reduced patient deaths,” said program leader Peter J. Pronovost, MD, PhD, of the departments of anesthesiology/critical care medicine and surgery at Johns Hopkins School of Medicine in Baltimore. “The challenge was to figure out how it worked.”
The Michigan program “explicitly outlined what hospitals had to do to improve patient safety, while leaving specific requirements up to the hospital personnel,” researchers found. Another critical aspect of the program was convincing participants that there was a problem they could solve.
“It was achieved by a combination of story-telling about real-life tragedies of patients who came to unnecessary harm in hospitals, and using hard data about infection rates,” said co-author Charles L Bosk, PhD, a sociology professor in School of Arts and Sciences at the Unversity of Pennsylvania.
The supportive atmosphere of the hospital team enabled doctors and nurses to “learn together, share good practice, and exert positive pressure on each other to achieve the best outcomes for patients,” noted lead author Dixon-Woods.
“What we have learned is that it is the local teams that deliver the results,” said Bosk. “But they need to be well-supported by a core project team, who have to focus on enabling hospital workers to get things right. That means providing them with scientific expertise to justify the changes they are being asked to make, and standardizing measures so they are all collecting the same data. It also means trying to figure out why simple changes that make life better are so difficult for health care delivery systems to do. Getting the whole program to work, rather than compliance with a single one component, is the key to making health care safer for patients.”