Mayo Clinics Model for Implementing Best Practices System-Wide Described, in the April 2013 Issue of The Joint Commission Journal on Quality and Patient Safety
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(Oak Brook Ill.—March 25, 2013 of the “The Joint Commission Journal on Quality and Patient Safety.” In the lead article, “Accelerating the Use of Best Practices: The Mayo Clinic Model of Diffusion,” James A. Dilling, B.S.I.E., CMPE, and colleagues at Mayo Clinic based in Rochester, Minn., outline the Mayo Clinic Model of Diffusion for evidence-based best practices, which was designed to address the longstanding challenge of moving translational research to the bedside. Mayo Clinic has used the model since January 2011 to successfully implement 14 best practices across its entire health system of 24 hospitals. The article describes the model’s development and its three primary enablers and five key elements, which work to embrace engineering principles, leverage effective spread techniques and establish the appropriate cultural environment for the diffusion of best practices.
“The Joint Commission Journal on Quality and Patient Safety,” published monthly by Joint Commission Resources, is a peer-reviewed journal, available by subscription, which serves as a forum for practical approaches to improving quality and safety in health care.
Methods, Tools, And Strategies
IBCD: Development and Testing of a Checklist to Improve Quality of Care for Hospitalized General Medical Patients
Anthony V. Aspesi, B.A.; Greg E. Kauffmann, B.A.; Andrew M. Davis, M.D., M.P.H.; Elizabeth M. Schulwolf, M.D., M.A.; Valerie G. Press, M.D., M.P.H.; Kristen L. Stupay, B.A.; Janey J. Lee; Vineet M. Arora, M.D., M.P.P.
Checklists, which have not received much attention in general hospital medicine, might increase adherence to quality indicators. Pocket cards featuring the IBCD checklist – (I) pneumococcal immunization, (B) pressure ulcers, (C) catheter-associated urinary tract infections, and (D) deep venous thrombosis – were used to remind residents at an academic medical center to perform one action for each of the four measures. The majority (70 percent) of the general medicine teams voluntarily used the checklist and incorporated it into their workflow without difficulty for 1,168 (54 percent) of 2,161 patients.
An Institution wide Approach to Redesigning Management of Cardiopulmonary Resuscitation
Geoffrey K. Lighthall, M.D., Ph.D.; Michael Mayette, M.D., FRCPC; T. Kyle Harrison, M.D.
Despite widespread training in basic life support and advanced cardiovascular life support among hospital personnel, the likelihood of survival from in-hospital cardiac arrests remains low. A university-affiliated tertiary medical center’s redesign of its cardiopulmonary resuscitation (CPR) system entailed creation of training programs to meet specific hospital needs, use of unannounced mock codes to provide system oversight, preparation and distribution of cognitive aids (printed algorithms, dosing guides, and other checklists), identification of patients who may be unstable or a source of concern, event review and analysis of arrests and other critical events, and a CPR website.
Accelerating the Use of Best Practices: The Mayo Clinic Model of Diffusion
James A. Dilling, B.S.I.E., CMPE; Stephen J. Swensen, M.D., M.M.M.; Michele R. Hoover, M.Ed.; Gene C. Dankbar, MSIE; Amerett L. Donahoe-Anshus, M.A.; M. Hassan Murad, M.D., M.P.H.; Jeff T. Mueller, M.D.
In the Mayo Clinic Model of Diffusion, diffusion of best practices depends on three primary enablers–culture, engineering, and infrastructure/systems support–and five key elements–leadership, Value Creation Teams, diffusion actions, operational implementation, and best practice review and maintenance. After a best practice is approved, it moves into the managed diffusion phase. Diffusion managers at each site shepherd this diffusion process, serving as “agents” to help carry out the change. Mayo Clinic has used this model to implement 14 best practices across the entire system of 24 hospitals in six states.
Using a Hospital Quality Improvement Toolkit to Improve Performance on the AHRQ Quality Indicators
Peter S. Hussey, Ph.D.; Rachel M. Burns, M.P.H.; Robin M. Weinick, Ph.D.; Lindsay Mayer, RN, M.S.N.; Julie Cerese, RN, M.S.N.; Donna O. Farley, Ph.D., M.P.H.
To help hospitals improve performance, a toolkit was developed to support quality improvement, including preparation, measurement, priority setting, implementation, and monitoring of sustained improvement. The toolkit focuses on the Agency for Healthcare Research and Quality’s Inpatient Quality Indicators and Patient Safety Indicators. A field test and evaluation of the toolkit suggest that hospitals face important challenges in quality improvement efforts, confirming the need for tools to assist them in this work.
Frontline Hospital Workers and the Worker Safety/Patient Safety Nexus
Rosemary Sokas, M.D., M.O.H.; Barbara Braun, Ph.D.; Laura Chenven, M.S.; Patricia Cloonan, Ph.D.; Kathleen Fagan, M.D., M.P.H.; Robin R. Hemphill, M.D., M.P.H.; Eileen Hogan, M.P.A.; Eileen Storey, M.D., M.P.H.
A day-long workshop was held in October 2012 to explore whether and how frontline health care workers affect patient safety and how they experience safety in their work settings. This report provides actions for hospitals to take in addressing the interrelated issues of patient safety and worker safety.