title: Multifocal Clinical Performance   Improvement Across 21 Hospitals.
abstract: Improving quality and safety across an entire healthcare system in multiple clinical areas within a short time frame is challenging. We describe our experience with improving inpatient quality and safety at Kaiser Permanente Northern California. The foundations of performance improvement are a “four-wheel drive” approach and a comprehensive driver diagram linking improvement goals to focal areas. By the end of 2011, substantial improvements occurred in hospital-acquired infections (central-line–associated bloodstream infections and Clostridium difficile infections); falls; hospital-acquired pressure ulcers; high-alert medication and surgical safety; sepsis care; critical care; and The Joint Commission core measures.
authors.forename: Barbara
authors.initials: B
authors.lastname: Crawford
authors.forename: Melinda
authors.initials: M
authors.lastname: Skeath
authors.forename: Alan
authors.initials: A
authors.lastname: Whippy
mesh_terms: D002140:California; D017598:Efficiency, Organizational; D006801:Humans; D007297:Inpatients; D009096:Multi-Institutional Systems; D017063:Outcome Assessment, Health Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D061214:Patient Safety; D058996:Quality Improvement / Q000458:organization & administration*