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  Johns Hopkins Hospital Uses High Reliability Approach on Accountability Measures, In the December 2013 issue of "The Joint Commission Journal on Quality and Patient Safety"  
(Oak Brook, Ill., December 3, 2013) Today, Joint Commission Resources announced the release of the December 2013 issue of the “The Joint Commission Journal on Quality and Patient Safety,” featuring an article on how the Johns Hopkins Hospital significantly improved performance on Joint Commission accountability measures. The hospital was recognized by the Top Performer on Key Quality Measures® program for using evidence-based care processes that are delivered in the right way and at the right time. In “Demonstrating High Reliability on Accountability Measures at The Johns Hopkins Hospital,” Peter J. Pronovost, M.D., Ph.D. and his co-authors explain how the organization developed and used a four-part conceptual model to systematically improve patient care processes.

Johns Hopkins leaders launched the initiative in December 2011 by clarifying and communicating goals, declaring that the target was 96 percent compliance with eight Joint Commission accountability measures and one Delmarva Foundation core measure. Clinicians and quality improvement staff formed one team for each targeted process measure, and the organization’s Armstrong Institute for Patient Safety and Quality staff supported the work of the teams.

Next, the organization conducted a gap analysis to prioritize improvement efforts and begin building capacity using Lean Sigma, education and clinical communities. To achieve the 96 percent goal, the Johns Hopkins board committed to transparently reporting results and developing a robust accountability plan that included monthly reports on compliance with the measures and appropriate follow-up. The final part of the model emphasized sustaining compliance with the 96 percent goal. The 96 percent performance goal was achieved for 95 percent of the measures in 2012 as opposed to 82 percent in 2011 before implementation of the conceptual model.

The authors suggest that this improvement work is novel and important for several reasons. Foremost, it demonstrated that large academic medical centers can significantly improve performance on accountability measures. To date, few academic medical centers have made The Joint Commission’s Top Performer on Key Quality Measures list. The authors also note that each aspect of the model, worked together with the other strategic elements, helped support system wide implementation and acceptance.

“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.


Medication Safety
The Effects of Electronic Prescribing by Community-Based Providers on Ambulatory Medication Safety

Erika L. Abramson, MD, MS; Elizabeth R. Pfoh, MPH; Yolanda Barrón, MS; Jill Quaresimo, RN, JD; Rainu Kaushal, MD, MPH

In a study of 20 community-based primary care providers, rates of prescribing errors with electronic health record (EHR) use were relatively low and were sustained over time. Extensive support for providers before, during, and after implementation may mitigate potential safety threats from implementation of an EHR system and result in sustained safety benefits over the long term.

Research Methods

Case Studies of Patient Safety Research Classics to Build Research Capacity in Low- and Middle-Income Countries 

Anne Andermann, MD, DPhil, CCFP, FRCPC; Albert W. Wu, MD, MPH; Angela Lashoher, MD; Peter Norton, MD, CCFP, FCFP; Narendra Kumar Arora, MD, MMSc; David W. Bates, MD, MSc; Itziar Larizgoitia, MD, on behalf of the Patient Safety Research Training and Education Expert Working Group of WHO Patient Safety

A 17-article series of patient safety research case studies illustrates how various research methods and study designs can be used to answer different types of research questions across five stages of the research cycle: (1) measuring harm, (2) understanding causes, (3) identifying solutions, (4) evaluating impact and (5) translating evidence into safer care.

Tool Tutorial
Online Toolkits for Metric-Driven Quality Improvement: The Veterans Health Administration Managed Grassroots Approach
Laura York, PhD; Bonnie Bruce, DrPH, MPH, RD; Jeff Luck, PhD, MBA; Candice Bowman, PhD, RN; Amanda M. Midboe, PhD; Nina Smith, MPH; Marlin Elenes, MPH; Jenny Girard, BS; Deborah Griffith, EdD; Gail Edwards, RN, BSN; Sangeeta Ahluwalia, PhD; Ann Zisser, RN, BS; Steven Asch, MD, MPH

To facilitate the spread of locally developed innovations, the Veterans Health Administration launched its Quality Improvement Toolkit Series, which provides a collaborative virtual environment anchored in performance measures across a variety of high-priority care conditions.

Rapid Response Systems
Developing a Medical Emergency Team Running Sheet to Improve Clinical Handoff and Documentation

Karen Mardegan, DPH, MNSc, PG Dip Crit Care Nursing, BN(Hons), RN; Melodie Heland, MN, Grad Dip Hlth Admin, Crit Care Nursing, BN, RN; Tiffany Whitelock, MPET, PG Cert. Acute Care, RN; Robert Millar, MB BS, FACEM; Daryl Jones, BSc(Hons), MB BS, FRACP, FCICM, MD

A novel Medical Emergency Team (MET) running sheet, developed to document events and therapies administered during MET calls, may facilitate handoff from ward nurses to the arriving MET.

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Joint Commission Resources (JCR), a not-for-profit affiliate of The Joint Commission, is the official publisher and educator of The Joint Commission. JCR is an expert resource for health care organizations, providing consulting services, educational services and publications to assist in improving quality and safety and to help in meeting the accreditation standards of The Joint Commission. JCR provides consulting services independently from The Joint Commission and in a fully confidential manner. Please visit our Web site at