Queen’s searches for ‘sweet spot’

Queen’s Health Systems has partnered with the Johns Hopkins Armstrong Institute in an ambitious attempt to dramatically improve patient safety over the next three years.

The health care provider has set a goal to reduce "preventable harm" by 50 percent as hospitals nationwide adjust operations to focus on quality outcomes demanded by insurers under new pay-for-performance reimbursement models.

Preventable hospital errors are the third leading cause of death in the U.S. — behind cancer and heart disease — responsible for an estimated 440,000 annual deaths, according to the Leapfrog Group, an independent industry watchdog group.

Officials of Queen’s and the Armstrong Institute for Patient Safety and Quality finalized an agreement this week to explore a long-term collaboration and the creation of a Quality and Patient Safety Institute at Queen’s Medical Center. They didn’t disclose the financial details of the partnership.

"This is the first one of its kind. We think the potential for this kind of peer learning is just remarkable," said Peter Pronovost, senior vice president for patient safety and quality at the $7 billion Johns Hopkins Medicine. Pronovost was named one of the world’s 100 most influential people by Time magazine. "It takes a style of leadership that could be unwavering in the goal but is humble enough to invite everybody else to help them get there."

Johns Hopkins envisions the creation of a "sister institute" at Queen’s where it would share learning in research, collaborate on training curriculum, rotate scholars and offer Queen’s faculty and staff professional development.

The institute is planning to send 16 people this week to assess operations at Queen’s and provide feedback on how to narrow gaps in quality or point out successes in which the industry can benefit.

"The idea too often is researchers do rigorous things but it’s not practical," Pronovost said. "Many operational quality improvement efforts are well intentioned but not grounded by science. We try to find a sweet spot."

The collaboration will focus on leadership style, governance and accountability, workplace culture and ultimately changing the mindset of all 6,300 Queen’s employees "so they come to work every day thinking they have two jobs. One is the job they’re hired to do, and the second is to improve the value we give to our patients," Pronovost said.

Queen’s will focus on reorganizing infrastructure to support quality, using data to evaluate quality, allowing patients and their families to play a key role in safety measures, changing the culture so employees are open to correcting anything unsafe and standardizing operations so that there is less chance for errors.

"We’re putting significant resources and efforts behind quality and safety," said Leslie Chun, chief quality officer for Queen’s. "Everyone on the front line needs to be committed to quality. They see things every day all the time. It’s been shown if you have the right culture, you can save a lot of lives. If we are going to get to those highest levels, we have to speak up because errors occur everywhere in every industry."

The collaboration is a pilot program that Johns Hopkins might eventually expand to other facilities.

"We have a number of other health systems in the U.S. and around the world that are interested in doing this," Pronovost said. "We really want to learn together with Queen’s how to make this right."

Both commercial insurers and Medicare and Medicaid, the government health insurance programs for seniors and low-income residents, have significantly changed payment models, tying more money to quality rather than volume.

"In the past, across the nation, more volume meant a better bottom line, so it’s counterintuitive and it is shaking up the industry nationally," Chun said. "It’s changing the way we look at health care. There are these cost drivers, but also the other component of it is we’re saying, ‘Are we as good as we can be?’"

While the partnership with Johns Hopkins does not include economies of scale, Queen’s will have direct access to experts on quality and safety. Pronovost will speak to Queen’s managers and other health care leaders Tuesday on the topic of "Becoming a National Leader in Patient Safety & Quality: The Armstrong Institute Journey."

"It’s an amazing thing for Hawaii," Chun said. "We’re partnering and collaborating with the leading minds in the world on how to get there. Even for a place as large as Queen’s, growing up in Hawaii, you realize contact to the mainland and to experts matter."