title: Demonstrating high reliability on accountability measures at the Johns Hopkins Hospital.
abstract: BACKGROUND
  Patients continue to suffer preventable harm from the omission of evidence-based therapies. To remedy this, The Joint Commission developed core measures for therapies with strong evidence and, through the Top Performer on Key Quality Measures program, recognize hospitals that deliver those therapies to 95% of patients. The Johns Hopkins Medicine board of trustees committed to high reliability and to providing > or = 96% of patients with the recommended therapies.
  
  
  METHODS
  The Armstrong Institute for Patient Safety and Quality coordinated the core measures initiative, which targeted nine process measures for the 96% performance goal: eight Joint Commission accountability measures and one Delmarva Foundation core measure. A conceptual model for this initiative included communicating goals, building capacity with Lean Sigma methods, transparently reporting performance and establishing an accountability plan, and developing a sustainability plan. Clinicians and quality improvement staff formed one team for each targeted process measure, and Armstrong Institute staff supported the teams work. The primary performance measure was the percentage of patients who received the recommended process of care, as defined by the specifications for each of The Joint Commission's accountability measures.
  
  
  RESULTS
  The > or = 96% performance goal was achieved for 82% of the measures in 2011 and 95% of the measures in 2012.
  
  
  CONCLUSIONS
  With support from leadership and a conceptual model to communicate goals, use robust improvement methods, and ensure accountability, The Johns Hopkins Hospital achieved high reliability for The Joint Commission accountability measures.
authors.affiliation: Armstrong Institute for Patient Safety and Quality, John Hopkins Medicine, Baltimore, MD, USA. ppronovo@jhmi.edu
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Pronovost
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins Health System, Baltimore, MD, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Demski
authors.affiliation: Armstrong Institute for Patient Safety and Quality, John Hopkins Medicine, Baltimore, MD, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Callender
authors.affiliation: Armstrong Institute for Patient Safety and Quality, John Hopkins Medicine, Baltimore, MD, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Winner
authors.affiliation: John Hopkins Children's Center, Baltimore, MD, USA.
authors.forename: Marlene R
authors.initials: MR
authors.lastname: Miller
authors.affiliation: Armstrong Institute for Patient Safety and Quality, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: J Matthew
authors.initials: JM
authors.lastname: Austin
authors.affiliation: The John Hopkins University, Baltimore, Maryland, USA.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Berenholtz
mesh_terms: D015142:Baltimore; D006739:Hospital Administration / Q000592:standards; D006761:Hospitals / Q000592:standards*; D006801:Humans; D007857:Leadership; D017146:Models, Organizational; D019982:Organizational Case Studies; D015279:Organizational Culture; D009936:Organizational Innovation; D061214:Patient Safety / Q000592:standards; D058996:Quality Improvement; D011787:Quality of Health Care / Q000458:organization & administration*