Application of Sustainability Framework for Quality Improvement in an Integrated Health System

Problem: Sustaining improvement in quality and patient safety is a critical challenge confronting healthcare today (Lennox, Maher & Reed, 2018). Failure to sustain the gains achieved with the improvement and results in harmful patient outcomes, wasted resources, and impact future improvement work (Lennox et al., 2018). Context: To address this challenge, the organization for this DNP project was a large, integrated healthcare system with 21 medical centers in Northern California with a redesigned a regional quality program to focus primarily on supporting the sustainability of patient safety initiatives that have been successfully implemented and spread. Interventions: Two frameworks from the Institute for Health Improvement (IHI) that promote leadership and frontline engagement have been selected to provide the basis for the sustainability approach for this project. In this context, two drivers of sustainability were implemented between January and May of 2020: a template for local sustainability oversight structure and the integration of clinical workgroups to engage and motivate frontline leaders and staff to sustain improvement. Measures: To measure the impact of this project on patient care outcomes, performance of the hospitals in patient harm prevention initiatives was monitored. To measure frontline engagement and their perception of leadership support, the scores in selected indices for engagement, team effectiveness, and organization of the annual safety culture and learning climate survey were obtained. APPLICATION OF SUSTAINABILITY FRAMEWORK. 5 Results: All 21 medical centers have reported having established the recommended local oversight structure by May 2020. Preliminary regional Safety Priority Index (SPI) in June was better than the target and showed a slight decrease from 2019 performance. People Pulse survey results in the selected indices in 2019 showed that in general, medical centers with preexisting formal oversight structure, scored higher than those without. Conclusions: Early indicators from this project are reflective of the current literature on this topic strongly suggesting that focused leadership support and motivated frontline are facilitators of sustainability of healthcare improvement (Scoville, Little, Rakner, Luther, & Mate, 2016; Hilton & Anderson, 2018)