Hospitals in Pursuit of Excellence-A Guide to Superior Performance Improvement

Ten years ago, the Institute of Medicine shocked the health care field and the general public with its seminal report, To Err is Human: Building a Safer Health System (1999), in which it estimated that as many as 98,000 people may die each year from preventable harm in hospitals. Its follow-up report, Crossing the Quality Chasm: A New Health System for the 21st Century (2001), introduced the IOM Six Aims for Improvement: care that is safe, timely, effective, efficient, equitable and patient-centered (STEEEP). These reports were a call to self-examination and action by the nation's hospital leaders.

Since then, many hospitals have made impressive strides in improving care along the 6 IOM aims. However, the incidence of harm and the level of quality in the health care delivery system continue to come under scrutiny. Calls for action by consumers, employers, purchasers and payers over excessive variation, unsafe environments and escalating costs have not waned. Recognizing the high stakes and that hospitals deliver complex services in complex settings, progress must continue to be made and at an even faster pace.

Despite the advances made during the past decade, daunting problems still confront hospital leaders and clinicians as they work to make care better and safer. According to the Centers for Disease Control and Prevention, 1.7 million health care-acquired infections occur in hospitals alone each year. In a 2006 report, the IOM put the number of preventable drug-related injuries in hospitals at about 400,000 annually. The United States has the highest medical care costs in the world (Organisation for Economic Co-operation and Development), yet it ranks only 37th in quality of care (World Health Organization).

The case studies in this guide illustrate that applying the principles of performance excellence to these areas can produce substantial patient and operational value and help hospitals deliver care that meets the 6 IOM aims. By demonstrating specific actions and results, hospitals can share measurable progress and stories of improvement with key stakeholders, including their patients, their communities, payers, regulators and others. The AHA pledges to help all hospital leaders do that.