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The History of the Armstrong Institute

"Never Again” | How a Medical Error led to Mike Armstrong’s Passion for Patient Safety

C. Michael Armstrong, past chairman of the board of trustees of Johns Hopkins Medicine, tells the story of the medical error that sparked his commitment to health care improvement and the creation of the Armstrong Institute for Patient Safety and Quality.

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.


Allen Kachalia, M.D., J.D. joined Johns Hopkins Medicine in January 2019 as the senior vice president of patient safety and quality and the director of the Armstrong Institute for Patient Safety and Quality. As the director of the Johns Hopkins Armstrong Institute for Patient Safety and Quality, Kachalia directs academic and scholarly efforts of the institute.

The Institute's First Director: Peter Pronovost

From 2011-2018, pioneering safety expert, Peter Pronovost, headed the institute, bringing 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.

Dr. Pronovost is the winner of several national awards, including the 2004 John Eisenberg Patient Safety Research Award, a coveted MacArthur Fellowship in 2008, known popularly as the “genius grant,” and the 2017 David E. Rogers Award from the American Association of Medical Colleges. Dr. Pronovost was named by Time magazine as one of the world’s 100 “most influential people” in the world for his work in patient safety.

For several years Pronovost has been named one of the top 50 physician executives by Modern Healthcare, which also listed him in 2014 and 2015 as one of the 100 most influential people in health care.

Dr. Pronovost developed a scientifically proven method for reducing the deadly infections associated with central line catheters. His simple but effective checklist protocol virtually eliminated such infections in ICUs across the state of Michigan, saving 1,500 lives and $100 million annually. The checklist protocol has since been implemented across the United States, state by state, and in several other countries. The New Yorker magazine says that Pronovost’s “work has already saved more lives than that of any laboratory scientist in the past decade.”

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.

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