Purpose of RWJF Grant

Pursuing Perfection PROGRAM OVERVIEW BACKGROUND:

Health care quality in America has serious problems.

A major study of fee-for-service Medicare beneficiaries found major quality deficits for acute myocardial infarction, breast cancer, diabetes, heart failure, pneumonia, and stroke (the median performance level was 69%). Also, the recent report from the Institute of Medicine, To Err is Human, estimated that as many as 98,000 people die each year from medical errors. Compared with other industries, the expectation for health care quality is very low. While the risk of death from riding on a set of recalled Firestone tires is much lower than risk of death from avoidable hospital error (0.063 per thousand vs. 2.9 per thousand), there has been comparatively little public outcry about hospital safety. In other industries, leading businesses view defect-free processes as their central business strategy for increasing market share and profits, and would not tolerate error rates comparable to those currently experienced in health care.

One reason for this situation is that no existing health care organization has shown that it is possible to achieve major quality improvements across their entire system. However, there are significant, albeit limited, examples of success in improving quality in health care. In the early 1980s, deaths from general anesthesia were more than 200 per million. But through rigorous systems analysis and a focused effort, the profession was able to cut this rate down to five per million.

The purpose of the Pursuing Perfection initiative is to show that system-wide efforts are feasible and, through such efforts, set new benchmarks for health care quality and safety. To pursue perfection, organizations will need to discover and apply the latest, most relevant knowledge. The application of medical science will be necessary but not sufficient to accomplish near-perfect care. Other useful knowledge areas include reliability engineering, human factors engineering, human resource development, communication, and behavioral psychology.

DETAILS ON THE INITIATIVE: This initiative will provide grants and technical assistance to up to 12 health care organizations to develop business plans that pursue perfection in health care across their organizations. Up to six of these organizations will be selected for major grants to implement their plans.

Phase 1: September, 2001 - March, 2002

Developing a Business Plan Under Phase I of Pursuing Perfection, up to 12 seven-month planning grants of $50,000 will be awarded to hospitals or physician organizations to develop a detailed business plan for how they will pursue perfect health care. The Institute for Healthcare Improvement will also arrange for consulting assistance to help grantees develop their plans. This assistance, valued at up to $50,000 per grantee, will be tailored to the specific needs of each grantee.

Each business plan must include:  A plan for piloting efforts that pursue perfect health care in at least two care processes as defined by national standard quality measures  A diffusion strategy within the organization that relies on training the bulk of the organization's clinical and administrative employees to redesign their processes based on the lessons from the pilots  A strategy for building partnerships beyond the boundaries of the organization as necessary to pursue perfect care for patients  An infrastructure-building strategy to support substantial, organization-wide improvements in such areas as clinical measurement, business processes, accounting, information systems, staff training, and human resources  A strategy to make the business case for efforts that pursue perfect health care  A leadership strategy that directly involves the CEO, medical leadership, and trustees or board members as persistent champions of the change, shouldering the burden of assuring that their organization continually and dramatically improves its care.

Phase II: April 2002 - March 2004

Implementing the Business Plan Based on the strength of their business plans, up to six of the providers who received grants under Phase I will be selected for major grants to support the implementation of those plans. Implementation grants will be for two years and range from $1.5 million to $3.5 million depending on the size and complexity of the provider.

By the end of two years, successful sites will have:  Produced nearly perfect care processes and substantial improvement in outcome indicators for at least two pilot care processes for all patients who experience that care process  Trained a sufficient proportion of the organization's staff in the skills needed to improve and redesign processes and systems to pursue perfect health care  Begun to pursue perfect health care projects in at least five other major care areas  Extended efforts to pursue perfect care processes to the services delivered by partnering organizations in the pilot areas  Adopted key infrastructure changes across the organization that were identified during the pilot projects  Completed a quantitative analysis supporting the case for making quality a central business strategy within five years from the start of Phase II  Demonstrated detectable changes in the entire organization's culture relevant to the pursuit of excellence, the priority of quality improvement, and the improvement of patient safety.

Feed back for Whatcom

The RWJ assessment team made these observation on the Whatcom project's strengths and weaknesses.

© Copyright 2004 Marcus Pierson, MD . Last update: 7/26/2004; 9:32:01 PM . This theme was created for WWPP by Jack F. Mancilla