IMPACT seeks breakthrough improvements in quality
IMPACT seeks breakthrough improvements in quality
Transparency,’ sharing of results to characterize IMPACT
It is certainly one of the most ambitious quality undertakings in recent memory. If it achieves its goals, it also will be one of the more transformative.
"It" is a network called IMPACT, created by the Boston-based Institute for Healthcare Improvement (IHI). So far, 58 health care organizations in 28 U.S. states and two Canadian provinces have joined IMPACT as charter members. "We hope to have 100 members by the end of the year and 400 by the end of next year," says Maulik Joshi, DrPH, IHI vice president and director of the new network.
IMPACT comprises health care organizations that are joining together to create a community of service providers committed to significantly improving patient care. IMPACT member organizations will work in five critical areas:
- Patient safety — ensuring that patients are as safe in their facilities as they are in their own homes;
- Office practice and outpatient settings — building efficient, proactive, patient-centered care systems for primary care, specialty practices, and ambulatory settings;
- Flow through the hospital — reducing waiting times, redundancy, and waste throughout the hospital system;
- Intensive care settings — improving care for patients in critical care units while reducing costs;
- Work force development — ensuring a vibrant, motivated, and skilled work force.
"There are many networks out there, but we differentiate ourselves as a collaborative group focused on results," Joshi says. IMPACT is not for everyone, he adds. "We’re going for the innovators, about 10% of the organizations." IHI doesn’t want to turn anyone away, however, and it has yet to do that. "It may be a process of self-selection," Joshi explains.
Each of the IMPACT member organizations has committed to making breakthrough improvements in one or more of the five areas during the next two years.
"It is hard to improve alone," notes IHI president and CEO Donald M. Berwick, MD, MPP. "That’s why we created IMPACT, a community of improvers who will learn and act together across organizations, disciplines, and even nations. Together, they will accelerate learning, cut the risks and costs of innovation, celebrate successes, and support each other to transform patient care."
The other challenge, Joshi adds, is to learn more about "how to bake quality into what you do."
Why they’re joining
For some of the charter members of IMPACT, joining the network was the next logical step in a long-term association with IHI. For many others, it is the next step in a quality improvement journey.
"We’ve had a fairly long history of pursuing QI and issuing QI techniques applied to health care," notes George Kerwin, president and CEO of Bellin Health System in Green Bay, WI. Bellin, which serves northeastern Wisconsin as well as the Upper Peninsula of Michigan, includes an acute-care hospital, a freestanding psychiatric hospital, and a freestanding baccalaureate college of nursing, and has partial ownership of a health plan.
"We’ve done a lot of work at the university around process control and other concepts," Kerwin says. "Early on in the mid-80s, we joined the quality management network, initiated by Don [Berwick] and a precursor to what’s going on now."
What does Kerwin hope to get out of IMPACT? "I see IMPACT as an evolution of this attempt to improve quality in health care," he says. "In the mid-80s, most of the work being done was primary education in QM [quality management] techniques. These efforts brought people from around the country to learn techniques like statistical process control and bring it back to their organizations. What I see IMPACT doing is now, with many dozens of organizations having learned and begun to apply and benefit from these concepts, they need to get together, apply them in different areas of health care, and share what they’ve learned."
"We believe there still is substantial room for improvement and to build on the improvements we have made, and that IMPACT will help accelerate this process," adds Gary Yates, MD, executive medical director of clinical effectiveness for Sentara Health System in Norfolk, VA.
Sentara, which also was a member of the QM network, includes five hospitals, a medical group, nine senior facilities, home health care services, and about 350,000 covered lives in managed care. "IMPACT seemed like the logical next step, especially with its emphasis on results," says Yates. (For more about joining IMPACT, go to the IHI web site: www.ihi.org.)
Each member organization is required to select at least one major area, or "domain," in which it will concentrate its efforts. Half the organizations that have signed up have selected two domains or more, Joshi says.
For each domain, the organization will sponsor an interdisciplinary team of four to six individuals. "They will pick specific aims, such as nurse retention, a healthier culture, or human resource processes," he explains.
Quality managers may be among the most important team members, Joshi says. "They provide a bridge between organizational leadership and the action team [the frontline individuals who actually will implement the project]," he explains. "Your team may include a psychiatric nurse, a scheduler, and so on, who may never have been involved in a quality improvement project. The quality manager can show them how the process works and get them really energized."
Participants will send representatives to attend leadership meetings twice a year to discuss issues such as the strategy of quality around their plans, how the issue affects their bottom line, and so forth. Over the course of a year, they will meet with others addressing the same domain.
"October will be the first domain learning session," Joshi says. "In this two-day session, aims will be identified, as well as actions to achieve those aims. Changes will be made and tested over four months, at which time they will meet again and check in."
During the interim, there will be numerous conference calls, use of an extranet, and so on. "This will be a very intense process," he says. "You can’t go a month without having to report out. You’ll be linked with a group within the same domain, or with an exact project if one exists. You go back, test, keep trying, and spread change as quickly as possible. There’s a lot of pressure knowing you’ll be on call or have to post updates to the extranet."
These efforts will be leveraged with IHI, which will be making available expert faculty to serve as mentors for these organizations. Their charge? To "nurture, provoke, and inspire."
"The organizations are providing the key concepts; we will provide a translation of a lot of the research," Joshi explains. "We will help explain what the research means to the organization — what they can do with this knowledge the next day. In other words, we identify practical solutions."
IMPACT offers an opportunity "to be with a great group of organizations that really want to collaborate and to push the envelope," Joshi says. "We’re looking to really turn it up a notch, and these content areas are the most pressing we face."
Kerwin and Yates already know what areas they’ll be studying. "We participated in idealized design of office practice, and one of our domains is evolution — dealing with an ambulatory setting," Kerwin says. "We’re also going to participate in the flow through the acute care setting."
"We have two hospitals participating," Yates says. "One will focus on critical care, the other on flow and access. In critical care, our EICU [emergency intensive care unit] project has been the focus of a lot of effort in the critical care area, including being the nation’s first EICU — but I still think there’s room for improvement."
As for flow and access in the emergency department, Yates says his system currently is efficient, "but spreading along the hospital, we want to eliminate waits throughout the system. This is especially important for us because we’ll be opening up a new hospital later this year, so hopefully this will provide a great laboratory for achieving a new level of efficiency."
What they learn from their own projects will be just part of the value of IMPACT; what they learn from others may be even more valuable.
"Benchmarking is so critical. For example, we have 25 organizations working on patient safety. Some may work on meds, for instance," Joshi says. "Those in that cluster will clearly be benchmarking each other. Even outside that specific area but within the same domain, they will be able to benchmark the learning. We think that’s the leverage of this network — to be able to learn quickly because you don’t always have to try it yourself."
In addition, the data from the projects will be studied over time, he says. "We believe in pragmatic science. So we’ll do a few charts, then check in a few months later, so participants can benchmark against themselves as well," Joshi explains.
"Benchmarking will be a significant part of participation for us," Kerwin adds. "Our main interest is to plug in with others, to learn from them, and possibly to teach them."
Benchmarking will play a key role, Yates notes, "because it will allow us to hopefully share our experience scenarios and to learn from each other, and really take the best practices and learn from them in a robust way."
"We are committed to sharing results across the whole network," Joshi emphasizes. "Transparency is key. If we find little interventions that make a big difference, we want everyone to know about it."
Ultimately, Yates says, health care professionals outside of IMPACT will be able to benchmark their learnings as well. "The new learning that occurs and the testing of each of the concepts will find their way out to the general profession. For the quality managers who participate, access to the expertise and change concepts that come out of the domains will clearly be very helpful for them. But one of our commitments is to be transparent, so hopefully we will also help others outside the network to learn quickly," he points out.
"One of the real fundamental philosophies of this group is to openly share with one another and get others involved," Kerwin says. "This is an effort to improve health care throughout this country, not to gain any advantage in the market."
Yates agrees. "In some ways, it’s about helping to transform the health care industry. We’re excited to be part of that."
Need More Information?
For more information, contact:
- Maulik Joshi, DrPH, Vice President, Institute for Healthcare Improvement, 375 Longwood Ave., Fourth Floor, Boston, MA 02215. Tele-phone: (617) 754-4822. Fax: (617) 754-4848. E-mail: [email protected].
- George Kerwin, President/CEO, Bellin Health System, 744 S. Webster Ave., P.O. Box 23400, Green Bay, WI 54305-3400. Telephone: (920) 433-7899. E-mail: [email protected].
- Gary Yates, MD, Executive Medical Director, Clinical Effectiveness, Sentara Health System, 600 Gresham Drive, Norfolk, VA 23507. Tele-phone: (757) 668-4850. E-mail: [email protected].
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