National Quality Program Achieves Improvements in Safety Culture and Reduction in Preventable Harms in Community Hospitals

摘要

Background: Through an innovative affiliation, Duke University Health System (DUHS), a large and complex academic health system, and LifePoint Health (LifePoint [LP]) collaborated to create a joint venture, DLP Healthcare (DLP) to measurably improve culture and quality and patient safety metrics in community hospitals across the United States. A structured approach to quality was developed in DLP hospitals and later refined and spread to all LP hospitals through the National Quality Program (NQP). Methods: The NQP was designed to drive organizationwide performance improvement through use of a framework of leadership, performance improvement, and culture. A comprehensive quality assessment of each DLP and LP hospital led to the creation of a customized improvement plan that was specific to the performance level of individual hospitals and aligned with strategic organizational goals. The improvement process was data driven, managed with defined improvement methodologies and practices, and implemented in a culture that honors teamwork, mutual respect, accountability and provider well-being. Results: Implementation of the NQP has led to significant improvements in patient safety metrics and in safety culture, which have now been sustained for more than seven years. Aggregate harm, as measured by administrative claims data-based harms per 1,000 inpatient-days, was reduced by 62.5% between January 2011 and December 2017, as compared to 2010 baseline data. Conclusion: The LP and Duke journey to achieve high reliability in community hospitals has yielded significant improvement in measures of patient safety and culture. The results are consistent with literature supporting the link between culture and overall performance.