Practice Forum
A region addresses patient safety*

https://doi.org/10.1067/mic.2002.122645Get rights and content

Abstract

The Pittsburgh Regional Healthcare Initiative (PRHI) is a coalition of 35 hospitals, 4 major insurers, more than 30 major and small-business health care purchasers, dozens of corporate and civic leaders, organized labor, and partnerships with state and federal government all working together to deliver perfect patient care throughout Southwestern Pennsylvania. PRHI believes that in pursuing perfection, many of the challenges facing today's health care delivery system (eg, waste and error in the delivery of care, rising costs, frustration and shortage among clinicians and workers, financial distress, overcapacity, and lack of access to care) will be addressed. PRHI has identified patient safety (nosocomial infections and medication errors) and 5 clinical areas (obstetrics, orthopedic surgery, cardiac surgery, depression, and diabetes) as ideal starting points. In each of these areas of work, PRHI partners have assembled multifacility/multidisciplinary groups charged with defining perfection, establishing region-wide reporting systems, and devising and implementing recommended improvement strategies and interventions. Many design and conceptual elements of the PRHI strategy are adapted from the Toyota Production System and its Pittsburgh derivative, the Alcoa Business System. PRHI is in the proof-of-concept phase of development. (Am J Infect Control 2002;30:248-51.)

Section snippets

A design for change

Three years ago, leaders of the Jewish Healthcare Foundation, a Pittsburgh-based hospital “conversion foundation,” met with Alcoa's then-Chief Executive Officer, Paul O'Neill (now Secretary of the Treasury), to discover how his company was addressing safety, costs, and quality simultaneously and achieving remarkable results. On the basis of that encounter and with support from the Conference on Community Development, a civic organization comprised of influential business leaders, the Pittsburgh

Patient safety: a commitment to perfection

PRHI's Patient Safety Initiatives are designed to establish the means for continuously improving safety and performance in each partner organization, its units, and the teams of workers who compose those units. These initiatives are dedicated to establishing a sustainable, region-wide structure that supports the delivery of exactly what patients need, when they need it, and without waste or error. This effort rests on participants' shared belief that any time perfect patient care does not

Learning to count together

PRHI's patient safety work is performed on the basis of the dynamic use of systems-based approaches to identify and address problems as they arise. To fix and continuously improve processes of care and their resulting outcomes, PRHI partners are deploying common mechanisms for identifying, capturing, sharing, and acting on the basis of incidents in which process performance is not optimal. PRHI partners are learning to count together. Multifacility, multidisciplinary advisory committees that

Infection control: initial areas of work

PRHI's surveillance and data collection, initiated April 1, 2001, targets catheter-associated bloodstream infections on intensive care units. This starting point affords several advantages, described in the following:

  • 1.

    Data regarding this category of infection are already collected by area facilities. (However, before deploying NNIS regionally, the methodology was not consistent between facilities).

  • 2.

    The frequency of catheter-associated bloodstream infections is low relative to other categories of

Accelerating learning

On the basis of PRHI's patient safety component, the health care industry in Southwestern Pennsylvania should derive tremendous improvements in patient outcomes, operations efficiency, and worker satisfaction. To accelerate progress toward these objectives, this patient safety work will soon support broader integration with PRHI's 5 clinical areas. PRHI's clinical programs are pursuing a similar strategy, in which procedural changes are made on the basis of process and outcomes data. Initially,

References (1)

  • Institute of Medicine

    To err is human

    (1999)

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Reprint requests: Edward I. Harrison, MBA, Pittsburgh Regional Healthcare Initiative, Jewish Healthcare Foundation, Centre City Tower, 650 Smithfield St, Suite 2330, Pittsburgh, PA 15222.

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