Community hospitals are increasingly affiliated with academic medical centers, but recent reports show no evidence of quality improvements. “I just don’t think we have the playbook quite right yet, nor do we have the measures,” said Elizabeth Mort, senior vice president of quality and safety and chief quality officer at Massachusetts General Hospital and the Massachusetts General Physicians Organization.

At the Armstrong Institute for Patient Safety and Quality Grand Rounds presentation on March 8, Mort shared the ways in which Massachusetts General has accelerated improvement in patient safety across its hospital system. Her top three approaches are:

1. Organize a steering committee.

Massachusetts General held its first internal Quality and Safety Steering Committee meeting in June 2016. From chiefs and quality chairs to nurses and techs, a group of about 60 people from across the hospital system met to discuss ways in which they can strengthen and learn bidirectionally with one another.

Despite concerns about a lack of budget, the committee determined quality and safety risk reduction priorities, organized a retreat and developed a framework for quality and safety programs. The time spent was well worth it, according to Mort: “It got people to think through how they were going to adjust, titrate their timing and figure out how to give-and-take a little bit to start this new work without significant new resources.”

Now in Phase II, the committee is beginning to put their framework into action and develop accountability structures across their institutions.

2. Look through the eyes of a trusted third party.

To evaluate their ability to identify and respond to vulnerabilities, Massachusetts General used CRICO, a medical malpractice insurance program serving the Harvard medical community. CRICO spent a few days looking at Massachusetts General and its entities from board to bedside, reviewing data and conducting interviews with frontline staff and leadership before providing feedback to each institution.

Another valuable perspective? Peer institutions. Several years ago, Massachusetts General and The Johns Hopkins Hospital took turns visiting one another in a peer-to-peer process adapted from the nuclear power industry. The teams conducted interviews with leadership and assessed each other’s strengths and opportunities. “It’s not dissimilar to what CRICO does, but we looked more intensely,” explains Mort. “This is a very, very powerful tool.”

At first, it took a while to build trust between the two teams. “There’s a little intrainstitutional competition historically there, let’s be honest,” says Mort. “But we got over it by sharing our problems.”

3. Develop a toolkit to support the hospital system.

The committee has been cataloguing quality and safety activities and developing a toolkit to continue strengthening its systems. As Massachusetts General has formalized its process over the last five years, colleagues from the community hospitals continue to ask questions. “All the time we were answering the phone and helping people out,” Mort says.

This enabled them to create programs that their hospital colleagues in the community wanted, all the while building trust, utility and value throughout the Massachusetts General family.

“I know the opportunity is there,” Mort emphasizes. “If we get our tools aligned and our playbook written, I think we can start to make progress.”

Watch the presentation: Accelerating Quality and Patient Safety Across a Hospital System: Lessons from Massachusetts General Hospital