System-Level Quality Improvement Initiatives: Lessons from Keystone and Other Large-Scale Projects

Robert Hyzy; Pat Posa; Damon C. Scales

doi:10.1055/s-0032-1322400

Seminars in Respiratory and Critical Care Medicine, Table of Contents

Semin Respir Crit Care Med 2012; 33(04): 370-374
DOI: 10.1055/s-0032-1322400

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

System-Level Quality Improvement Initiatives: Lessons from Keystone and Other Large-Scale Projects

Robert Hyzy

¹Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan

,

Pat Posa

²St. Joseph Mercy Health System, Ann Arbor, Michigan

,

Damon C. Scales

³Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada

⁴Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

› Author Affiliations

Abstract

Health care systems around the world are seeking system-level interventions to improve the quality and safety of care because of increasing awareness that many patients do not receive recommended therapies or suffer preventable complications. This has also been motivated by a drive to deliver health care more cost-effectively, and to be more accountable to payers and other stakeholders. The Keystone Project in Michigan is one example of a large-scale system-level initiative that successfully changed the “culture of safety” in the intensive care units of participating hospitals and led to improvements in both process outcomes and clinical outcomes. This article discusses factors that contributed to the success of the Keystone Project and also considers its economic implications. There are also recommendations for the design and evaluation of future system-level quality improvement programs.

Keywords

quality improvement - cost-effectiveness - patient safety - critical care - intensive care units - health economics

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References

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