Clinical Communities at Johns Hopkins Medicine: An Emerging Approach to Quality Improvement

Gould, Lois; Wachter, Patricia; Aboumatar, Hanan; Blanding, Renee; Brotman, Daniel J.; Bullard, Janine; Gilmore, Maureen; Golden, Sherita Hill; Howell, Eric; Ishii, Lisa E.; Lee, K. H. Ken; Paul, Martin G.; Rotello, Leo; Satin, Andrew J.; Wick, Elizabeth C.; Winner, Laura; Zenilman, Michael E.; Pronovost, Peter J.

doi:10.1016/s1553-7250(15)41050-5

Cited by 27 publications

(25 citation statements)

References 11 publications

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“…Individual health systems can also implement their own local collaboratives, or “clinical communities,” as has been done across Johns Hopkins Medicine. 38,39 These are clinician-led, interdisciplinary groups that focus on improving quality within defined care settings (for example, ICU), across a group of similar providers (hospitalists), or for specific patient populations (congestive heart failure), and that are supported by institutional resources, such as support for project management and data acquisition and analysis. The objective of this recommendation is to promote the consideration and use of bottom-up strategies that leverage intrinsic motivation and attenuate the unreflective, top-down use of P4P as a fix-all solution.…”

Section: Recommendations To Improve Motivation In Health Carementioning

confidence: 99%

Physician Motivation: Listening to What Pay-for-Performance Programs and Quality Improvement Collaboratives Are Telling Us

Herzer

Pronovost

2015

The Joint Commission Journal on Quality and Patient Safety

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Section: Recommendations To Improve Motivation In Health Carementioning

confidence: 99%

Physician Motivation: Listening to What Pay-for-Performance Programs and Quality Improvement Collaboratives Are Telling Us

Herzer

Pronovost

2015

The Joint Commission Journal on Quality and Patient Safety

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“…These hospital communities are powerful vehicles in changing the overall behaviour and beliefs to "I" can do something about it (Pronovost, Cleeman, Wright, & Srinivasan, 2015). The power of peer communities comes from peer learning and tapping into intrinsic motivation among professionals (Dixon-Woods, Leslie, Tarrant, & Bion, 2013;Gould et al, 2015). This concept has not reaped rewards in others (Reames, Krell, Campbell Jr., & Dimick, 2015;Urbach, Govindarajan, Saskin, Wilton, & Baxter, 2014).…”

Section: Resultsmentioning

confidence: 99%

Analysis of Development in Patient Safety Over the Last 15 Years

Ehrnsperger¹

2016

UCPA

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Patient safety is a significant healthcare issue with substantial clinical and economic consequences. The extensive research in 1999 on patient safety stated that preventable medical errors in US were killing as many as 99,000 people per year. The aim of this paper is through the analysis of patient safety management development to identify main obstacles and success factors for its improvement, coming from global literature review combined with a case study. The literature review was a qualitative meta-analysis from which identified barriers and critical success factors for improvement. This research is underlined by a case study which also shows clear adoption barriers. In the result of analysis of literature review and secondary statistical data, main conclusions can be stated such as: (1) The scope of improving patient safety has not made significant progress and further efforts are rare and not centred;(2) Several macroeconomic obstacles are still observable end especially in the field of commitment, funding, and education, but main attention paid by author of this paper is the analysis of managerial aspects of patient safety at micro-level which is creating the third group of conclusions.

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“…While the theory underpinning the clinical community model has been set out in some detail (Aveling et al., 2012a), how to deploy it effectively is less well understood (though see Gould et al., 2015 for some examples). We seek to advance this through comparative analysis of two case studies, focusing particularly on lessons for developing effective vertical and horizontal structures and striking the right balance between them.…”

Section: Introductionmentioning

confidence: 99%

Optimising the community-based approach to healthcare improvement: Comparative case studies of the clinical community model in practice

Aveling

Martin

Herbert

et al. 2017

Social Science & Medicine

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Community-based approaches to healthcare improvement are receiving increasing attention. Such approaches could offer an infrastructure for efficient knowledge-sharing and a potent means of influencing behaviours, but their potential is yet to be optimised. After briefly reviewing challenges to community-based approaches, we describe in detail the clinical community model. Through exploring clinical communities in practice, we seek to identify practical lessons for optimising this community-based approach to healthcare improvement. Through comparative case studies based on secondary analysis, we examine two contrasting examples of clinical communities in practice – the USA-based Michigan Keystone ICU programme, and the UK-based Improving Lung Cancer Outcomes Project. We focus on three main issues. First, both cases were successful in mobilising diverse communities: favourable starting conditions, core teams with personal credibility, reputable institutional backing and embeddedness in wider networks were important. Second, top-down input to organise regular meetings, minimise conflict and empower those at risk of marginalisation helped establish a strong sense of community and reciprocal ties, while intervention components and measures common to the whole community strengthened peer-norming effects. Third, to drive implementation, technical expertise and responsiveness from the core team were important, but so too were ‘hard tactics’ (e.g. strict limits on local customisation); these were more easily deployed where the intervention was standardised across the community and a strong evidence-base existed. Contrary to the idea of self-organising communities, our cases make clear that vertical and horizontal forces depend on each other synergistically for their effectiveness. We offer practical lessons for establishing an effective balance of horizontal and vertical influences, and for identifying the types of quality problems most amenable to community-based improvement.

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Clinical Communities at Johns Hopkins Medicine: An Emerging Approach to Quality Improvement

Cited by 27 publications

References 11 publications

Physician Motivation: Listening to What Pay-for-Performance Programs and Quality Improvement Collaboratives Are Telling Us

Physician Motivation: Listening to What Pay-for-Performance Programs and Quality Improvement Collaboratives Are Telling Us

Analysis of Development in Patient Safety Over the Last 15 Years

Optimising the community-based approach to healthcare improvement: Comparative case studies of the clinical community model in practice

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