Measuring the quality and safety of the care we provide, and then making people throughout the organization responsible for improving on those measures, is key to driving improvement in the safety, quality and efficiency of care.
At Johns Hopkins, accountability for quantifiable improvement is shared by executive leaders, departmental chairs, nursing leaders, administrators and unit-based managers.
We bring about this culture of accountability, in part, through such tools as quality and safety board reports and departmental safety dashboards. The Johns Hopkins Monthly Safety Dashboard, for example, includes measures of key strategic priorities—health care-associated infections and complications, medication errors, culture of safety, hand hygiene—and allows departmental leaders to include additional areas of concern. The Department of Orthopedics chose to add compartment syndrome to its departmental safety dashboard as an area of focus. Departments may also choose to target certain types of medication errors or infections that occur most often in their departments. This customization of the Monthly Safety Dashboard ensures that organizational priority areas are being addressed, while at the same time the dashboard is locally important and actionable to departmental leadership.
Accountability for quantifiable improvements is based on monetary and non-monetary incentives. In and of themselves, measurement and report cards are an intervention that can drive improvement. Performance on these is reported at many venues, from quality improvement meetings all the way to the board. Executives and departmental leaders are motivated to be high performers. Accountability also includes celebration and sharing of successes as positive reinforcement and promoting positive deviance. Finally, 30 percent of leaders’ incentive compensation at Hopkins is based on performance on the Safety Dashboard as well as the less tangible notion of their engagement in our “culture of improvement.” Combined, these incentives build a culture of accountability for improvement.