The 100,000 Lives Campaign: Six Months In

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The 100,000 Lives Campaign Six Months In

• Donald M. Berwick, MD, MPP
• Institute for Healthcare Improvement
• 1st Annual Summit on Redesigning Hospital Care
• San Diego, CA June 9, 2005
• www.ihi.org

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IHIs No Needless List

• No needless deaths
• No needless pain
• No helplessness
• No unwanted waiting
• No waste
• for anyone

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The latest large study

• McGlynn, et al The quality of health care
  delivered to adults in the United States. NEJM
  2003 348 2635-2645 (June 26, 2003)
• 439 indicators of clinical quality of care
• 30 acute and chronic conditions, plus prevention
• Medical records for 6712 patients
• Participants received 54.9 of scientifically
  indicated care (Acute 53.5 Chronic 56.1
  Preventive 54.9)
• Conclusion The Defect Rate in the technical
  quality of American health care is approximately
• 45

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Core Conclusions

• There are serious problems in quality
• Between the health care we have and the care we
  could have lies not just a gap but a chasm.
• The problems come from poor systemsnot bad
  people
• In its current form, habits, and environment,
  American health care is incapable of providing
  the public with the quality health care it
  expects and deserves.
• We can fix it but it will require changes

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Campaign Objectives

• Save 100,000 Lives
• Enroll more than 2,000 hospitals in the
  initiative
• Build a reusable national infrastructure for
  change

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Key Campaign Principles

• Some is not a number soon is not a time.
• Welcome anyone at any level.
• We do this together.

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Six Changes That Save Lives

• Deploy Rapid Response Teams
• Deliver Reliable, Evidence-Based Care for Acute
  Myocardial Infarction (Heart Attacks)
• Prevent Adverse Drug Events (ADEs)
• Prevent Central Line Infections
• Prevent Surgical Site Infections
• Prevent Ventilator-Associated Pneumonia

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Baptist-DeSoto HSMR (Hospital Standardized
Mortality Rate)
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Campaign Status

• Over 2,200 hospitals enrolled in all 50 states
• Nearly 50 of U.S. hospital beds
• Thousands on national calls
• Unprecedented web activity and new tool
  development
• Related campaigns forming globally
• Data collection underway with Pioneer Group
  begins for all enrollees on June 14, 2005

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Extraordinary Support

• Over 35 nodes and counting
• Vibrant partnerships (AAMC, AHRQ, AMA, AHQA, ANA,
  Ascension, CMS, CDC, JCAHO, Leapfrog, NPSF, NRHA,
  NC State Hosp. Assoc., Premier, Qualis, SSM, UHC,
  VA, VHA)
• Generous financial backing (BCBS of MA, Moore
  Foundation, Leeds Family, Rx Foundation, Blue
  Shield of CA Foundation, Colorado Trust, Cardinal
  Health Foundation)

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Campaign Participants So Far (a sample)

• American Medical Association, American Nurses
  Association, American College of Physician
  Executives, Association of American Medical
  Colleges, JCAHO, Leapfrog Group, NPSF, Premier,
  University HealthSystem Consortium, VHA
• Leading systems SSM Health Care, Ascension
  Health, Hospital Corporation of America, Tenet
  Health Care
• State Hospital and Nurses Associations MA, NC,
  IL, MI, WA.
• Federal Agencies CMS, CDC, AHRQ, VA
• Scientific Societies ACC, American Heart
  Association, APIC, SCCM, SHEA, SGIM
• Pediatric (NICHQ, NACHRI, CHCA) and rural (NRHA)
  nodes
• AHQA (Quality Improvement Organizations)
• Financial support BCBS of MA, Moore Foundation,
  Leeds Family, Rx Foundation, Blue Shield of CA
  Foundation, Colorado Trust, Cardinal Health
  Foundation
• Over 2,200 hospitals so far And counting

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Getting Down to Work

• Enrollment is exciting but insufficient on its
  own. Lets seize the opportunity weve created
• We need to introduce these interventions reliably
  in every participating hospital by engaging
  leaders, front line providers, patients, and
  families
• All Campaign stakeholders IHI, partners, nodes,
  hospitals have to pull together to support
  implementation
• Start with small steps within your organization
  (use the new guide to hospital-wide Campaign
  activity available on www.ihi.org today)

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Campaign Timeline
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Supports and Events

• New Campaign Progress page of www.ihi.org
  launches today
• Campaign-wide data submission begins June 14
  (Preparatory National Call June 13 see Campaign
  website for details)
• June 23 National Call on implementation
  strategies
• Nationwide Summer Tourthe Campaign is coming to
  a city near you
• Round Two of National Calls on each intervention
  this July
• 100K LIVE! call-in shows begin in July

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Implementation Individual Hospitals

• Plan for the involvement of several different
  groups within your organizations
• The front line providers of care
• The Board
• The leadership team
• All staff
• Patients and families
• Community groups
• Make the Campaign your own

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Implementation Individual Hospitals

• How to jump start the Campaign
• Select your interventions
• Build your teams
• Hold a rally
• Listen to national calls (and recordings)
• Review Campaign materials (including schedule,
  forthcoming check lists and assessment tools)
• Learn more about improvement
• Create a work plan

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Look. This Is Not Going to Be Easy!

• Technical changes and cultural changes
• Reliability of bundles composites no
  partial credit
• Automation, standing orders, default systems
• Teamwork
• Valuing initiative from everyone (nurses,
  pharmacists, all..)
• Pretend the goal is 3 months away, not 12 months
  away audit in July, 2005
• Are the process changes being made? Really?
• Are deaths decreasing? Really?
• Revisit and redesign implementation accordingly
  by September 1, 2005
• Fail First Learn Then Succeed
• Use the whole Campaign system. You are part of
  something very big, ambitious, and wonderful.
  Use It!

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REALLY?

• We are already doing the six changes.
• REALLY?
• Our care for (heart attacks, surgical sites,
  central lines, ventilator patients, medication
  reconciliation) is highly reliable?
• REALLY?
• Our nurses are empowered to act when they get
  worried, and to get support immediately and
  without criticism.
• REALLY?
• We are connected to the Campaign community, and
  learning from it every day.
• REALLY?
• We are saving lives now that we would not have
  before.
• REALLY?

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THE Question for the Next Three Months

• REALLY?

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For more information...

• www.ihi.org/campaign

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Some Is Not a Number Soon Is Not a Time

• The Number
• 100,000 Lives
• The Time
• June 14, 2006 9 a.m. ET