Tuesday, November 15, 2011

Hospitals Reduce Bloodstream Infections: Performance Improvement in Action

This article from The Tennessean provides a nice overview of gains made by hospitals in the state to reduce bloodstream infections related to catheters - a hospital-acquired condition that can be deadly. The secret to their success? They applied principles of performance improvement:
  • The State Department of Public Health started collecting data across institutions.
  • US Department of Health and Human Services established a benchmark for all hospitals to aspire to.
  • Hospitals started following a "safety checklist", including the following elements:
    • thoroughly wash hands
    • wear sterile protective garb
    • avoid putting catheters in the garb
    • cleanse the infection site 
    • remove catheters as soon as they are no longer needed
  • Centennial and Methodist University Hospital committed to transparency by posting their numbers on their own websites.
  • Vanderbilt increased awareness about the initiative by posting signs counting "days since the last infection".
  • Vanderbilt developed an "antibiotic stewardship program" to closely monitor use of antibiotics which has helped to reduce the incidence of multi-drug resistant pathogens.
It is gratifying to see initiatives like this taking hold as other states have also been reporting positive outcomes with their collaborative efforts. However, there is a lot of improvement work to be done! Federal and state officials should provide a greater impetus to such initiatives - lead more collaborative efforts, aim for higher targets, and try to achieve the gains faster. The hospitals that have not achieved gains at the same rate as others may need more assistance from the state or other agencies in setting up their performance improvement systems.


  1. The secret sauce that fuels these inroads is internal commitment. Many institutions simply go through the motions of process improvement without the passion or "permission" to do what it takes, or lacking the skills to effectively manage the process. If you study the most resonant successes, you see that achieving success takes hard work, every day...and sustaining these gains is even harder. As new economic realities drive more institutions to seek solutions, the hope is that a greater body of replicable templates and strategies for success will emerge. Commitment may become more commonplace when the road to improvement comes with better mapping. Everyone wins - especially the patient.

  2. Thanks Pat, I agree with you on the need for internal commitment - which is at a low at many institutions because of the complexity of the climate and challenges with leadership. However, what I've experienced is that once the frontline staff are trained to make the right changes, connect them together, and see the results starting to flow, commitment starts to build. One of the outcomes of "performance improvement systems" is improved results, but the other outcomes are increased confidence in "the system" and as a result increased commitment from the staff. Its a culture of improvement that gets created, and we need to figure out how to seed this effectively in our healthcare institutions.