The Creation of the Armstrong Institute
In 1999, the Institute of Medicine published a landmark report, To Err is Human, in which it identified patient safety as a significant nationwide problem. The authors estimated that at least 44,000—and perhaps as many as 98,000—Americans die in hospitals every year due to medical errors. The solution, stated the report, required focusing on fixing flawed care delivery systems and not blaming providers. Since that time, research has suggested that the number of deaths attributable to errors may be many times greater than the Institute of Medicine estimated.
Despite a great deal of attention from clinicians, researchers, administrators, medical professionals and others since the release of the report, health care institutions have not made substantial gains in patient safety. Too often, successful projects occur in areas of limited scope and their lessons are not spread throughout health care organizations. There are poor processes for rapidly translating scientific findings—for example, what interventions have evidence to prove that they work—into programs that can be widely implemented. Significant progress requires new approaches and new ways of thinking.
Championing Patient Safety
Among the strongest voices for change has been C. Michael Armstrong, retired chairman of Comcast, AT&T, Hughes Electronics and IBM World Trade Corporation and chairman of the board of trustees of Johns Hopkins Medicine. Armstrong has long championed the need to focus on patient safety and quality of care. In board meetings, he makes sure that safety is the first agenda item. He is determined that Johns Hopkins Medicine will take patient safety research and results to the next level.
In 2011, Armstrong made a $10 million gift to create The Armstrong Institute, dedicated to increasing patient safety and reducing medical errors within the Johns Hopkins system as well as at hospitals and medical centers around the world.
Headed by pioneering safety expert, Peter Pronovost, the institute brought together two Hopkins groups already working on solutions—the Quality and Safety Research Group and the Center for Innovation in Quality Patient Care—as well as other safety and quality specialists from across Johns Hopkins.
The Forerunners of the Armstrong Institute
Center for Innovation in Quality Patient Care
Created in 2002, the Center for Innovation created new models of health care delivery that improved patient safety, quality and efficiency. Center experts developed resources, tools and training programs that engaged health care workers—from frontline staff to top leadership—to realize measurable advances in care delivery at The Johns Hopkins Hospital and at the Johns Hopkins Health System.
The center also leveraged its experience at Johns Hopkins to help hospitals in the United States and around the world develop or expand their quality and safety programs by guiding their leaders, managers and staff to be forces for change within their own institutions.
Quality and Safety Research Group
In 2003, Dr. Pronovost established the Quality and Safety Research Group (QSRG) to advance the science of safety and make patient care safer worldwide. QSRG led and participated in regional, national and international research projects that reduced preventable complications and saved thousands of lives. The research team helped to set the national agenda for patient safety and quality improvement and influenced policy development in these areas. Its researchers developed tools—in areas such as teamwork and communication—that have been widely adopted.
QSRG developed interventions that are grounded in science, involve rigorous measurement and testing and can be implemented on a broad scale. Among the group’s more noteworthy achievements is a project that virtually eliminated central catheter-related bloodstream infections across more than 100 intensive care units in Michigan. The team then led a national four-year project across 44 other states that reduced such infections by 40 percent, preventing an estimated 500 deaths.
Leading Change and Innovating Solutions
The formation of the institute represented an acknowledgement of the need to take quality and safety to the next level at Johns Hopkins Medicine and in the larger health care world. Through the institute, Johns Hopkins has a framework to tackle health care’s challenges head on, ensure organizational learning, and to spread solutions to colleagues across Johns Hopkins Medicine and the world. The institute’s unique combination of rigorous patient safety research with health system operations fosters more rapid translation of new knowledge to the bedside while providing scientific evaluation of safety interventions.