2. Safe – no needless deaths Effective – no needless pain or suffering
Patient-Centered – no helplessness in those served or serving
Timely – no unwanted waiting
Efficient – no waste
Equitable – for all
The IHI’s blueprint for its work – the goals we aspire to – come from the Institute of Medicine’s landmark 2001 report, Crossing the Quality Chasm: A New Health Care System for the 21st Century. In it, the IOM identified six urgently needed “Aims for Improvement” of health care in America. IHI has translated these goals into what we call the “No Needless” list:
Safe – To reduce the harm done to patients by errors in care – defects which, according to the IOM, kill between 44,000 and 98,000 Americans each year in hospitals alone;
Effective – To promise patients that they will receive care faithfully according to science, and that they will not be subjected to care that cannot help them;
Patient-centered – To redesign care so as to restore dignity, self-esteem, and control to patients and families who too often feel helpless, forgotten, and unheard;
Timely – To reduce the waiting and delays that pervade health care for both patients and those who give the care;
Efficient – To recover a substantial portion of the money wasted in health care through administrative complexity, unnecessary procedures, and lack of coordination;
Equitable – To close the racial and socio-economic gaps in health status, access, and outcomes. 2

3. Improvement and Support Team Patient Experience
Collaboratives
Patient Experience
Healthcare Acquired Infections Taskforce
E-Health

4. Safety

5. Why?

6. James Adams

7. How many people are
harmed in
our healthcare system?

8. Atul Gawande, “The Bell Curve” The New Yorker, December 6, 2004
“It used to be assumed that differences among hospitals or doctors in a particular specialty were generally insignificant. If you plotted a graph showing the results of all the centers treating cystic fibrosis—or any other disease, for that matter—people expected that the curve would look something like a shark fin, with most places clustered around the very best outcomes. But the evidence has begun to indicate otherwise. What you tend to find is a bell curve: a handful of teams with disturbingly poor outcomes for their patients, a handful with remarkably good results, and a great undistinguished middle.”

9. Scottish Patient Safety Programme
What?
Scottish Patient Safety Programme

10. Outcome Aims Mortality: 15% reduction Adverse Events: 30% reduction
Ventilator Associated Pneumonia: 0 or 300 days between
Central Line Bloodstream Infection: 0 or 300 days between
Blood Sugars w/in Range (ITU/HDU): 80% or > w/in range
MRSA Bloodstream Infection: 30% reduction
Crash Calls: 30% reduction
Harm from Anti-coagulation: 50% reduction in ADEs
Surgical Site Infections: 50% reduction

11. Interventions Medicines Critical Care Ward Theatres Leadership
Ventilator acquired pneumonia bundle, central line
Ward
Early rescue
Communication
Medicines
Medicines reconciliation
Theatres
Surgical pause
Infection prevention/control
Leadership
Safety walkrounds
Executive leadership board patient safety profile

12. How?

13. The first law of improvement
Every system is perfectly designed to achieve exactly
the results it gets.
Peter Senge The Fifth Dimension

14. The Improvement Guide, API

15. Looking for Harm

18. Board examples Leadership walkarounds Surgical briefings Handwashing
Bedside cabinets
Surgical briefings
On theatre lists
Four new staff
Handwashing
100%
Critical care bundles
Runcharts